Rates of combination antiretroviral treatment change in Australia, 1997–2000

Petoumenos, Kathy; Austin, Danielle; Baker, David; Block, Michael S.; Brown, Katie; Carr, Andrew; Cooper, David A.; Couldwell, Deborah L.; Ellis, Deborah A.; Finlayson, Robert; Gorton, Carla; Gowers, Andrew; Keeffe, N.; Kidd, J; Law, Matthew; Liang, M.T.; McFarlane, Robert M.; Mutimer, K; Miller, John P.; O’Connor, Catherine; Quan, Dick; Rooney, P. J.; Taylor, Simeon I.; Smith, Don; Wheatley, David; Knibbs, Peter; Huffam, Sarah; Morgan, Stephanie; Savage, Jan; Bradford, David L.; Chuah, John; Dickson, B.; Fankhauser, W.; Lister, G. G.; Magon, H; Orth, David N.; Rawlinson, Mary C.; Rée, Hugo; Sowden, David; Walker, A.S.; Wilson, Claire; Anderson, J.; J, Bal; Daye, Jad; Eu, Beng; Fairely, C.K.; Hoy, Jennifer; McCormack, Clare; McGovern, George; McNair, Ruth; Medland, Nicholas; Mijch, Anne M; Rd, Moore; Pierce, Amy; Roth, Norman; Russell, Darren; Strecker, Stefan; Watson, Kerrie; Wood, Hayley; Cain, A.; French, Matthew; Mallal, S.; Maxwell, Donald M.; Moore, Christopher; Skett, J.

doi:10.1046/j.1464-2662.2001.00094.x

Cited by 63 publications

(35 citation statements)

References 12 publications

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“…AHOD uses methodology which has been described in detail elsewhere (20). Data are transferred electronically to The Kirby Institute, University of New South Wales every 6 months.…”

Section: Methodsmentioning

confidence: 99%

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

et al. 2014

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Background There have been improvements in combination antiretroviral therapy (cART) over the last 15 years. The aim of this analysis was to assess whether improvements in ART have resulted in improvements in surrogates of HIV outcome. Methods Patients in the Australian HIV Observational Database who initiated treatment using mono/duo therapy prior to 1996, or using cART from 1996 onwards, were included in the analysis. Patients were stratified by era of ART initiation. Median changes in CD4+ and the proportion of patients with detectable HIV viral load (>400 copies/ml) were calculated over the first 4 years of treatment. Probabilities of treatment switch were estimated using the Kaplan-Meier method. Results 2,753 patients were included in the analysis: 28% initiated treatment <1996 using mono/duo therapy; and 72% initiated treatment ≥1996 using cART (30% 1996–99; 12% 2000–03; 11% 2004–07; and 19% ≥2008). Overall CD4 response improved by later era of initiation (p<0.001), although 2000–03 CD4 response was less than that for 1996–99 (p=0.007). The average proportion with detectable viral load from 2 to 4 years post treatment commencement by era was: <1996 mono/duo 0.69 (0.67–0.71); 1996–99 cART 0.29 (0.28–0.30); 2000–03 cART 0.22 (0.20–0.24); 2004–07 cART 0.09 (0.07–0.10); ≥2008 cART 0.04 (0.03–0.05). Probability of treatment switch at 4 years after initiation decreased from 53% in 1996–99 to 29% after 2008 (p<0.001). Conclusions Across the five time-periods examined, there have been incremental improvements for patients initiated on cART, as measured by overall response (viral load and CD4 count), and also increased durability of first-line ART regimens.

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“…AHOD uses methodology which has been described in detail elsewhere (20). Data are transferred electronically to The Kirby Institute, University of New South Wales every 6 months.…”

Section: Methodsmentioning

confidence: 99%

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

et al. 2014

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“…This rate was much lower than the overall observed rate of ART changes in treatment-experienced patients in AHOD, where around 45 second-line changes and 60 third-line changes occur every 100 person-years. 29 However, these rates considered ART change as the addition of any ARV drug to the existing regimen and may overestimate the regimen switches between ARV drug classes.…”

Section: Discussionmentioning

confidence: 99%

“…A more detailed description of the methodology for AHOD has been previously described elsewhere. 20 Briefly, data collected for AHOD includes basic demographics, hepatitis serology, CD4 and CD8 cell counts, HIV viral load, antiretroviral treatment history and cause of death. Genotypic resistance to ARV drug classes is not collected.…”

Section: Methodsmentioning

confidence: 99%

Treatment durability and virological response in treatment-experienced HIV-positive patients on an integrase inhibitor-based regimen: an Australian cohort study

Mata¹,

Cooper²,

Russell

et al. 2016

Sex. Health

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Background Integrase inhibitors (INSTI) are a newer class of antiretroviral (ARV) drugs that offer additional treatment options for experienced patients. Our aim is to describe treatment durability and virological outcomes in treatment-experienced HIV-positive patients using INSTI-based regimens. Methods All patients in the Australian HIV Observational Database who had received an INSTI-based regimen ≥14 days as well as previous therapy were included in the study. We defined two groups of treatment-experienced patients: (1) those starting a second-line regimen with INSTI; and (2) highly experienced patients, defined as having prior exposure to all three main ARV classes, nucleoside reverse transcriptase inhibitor, nonnucleoside reverse transcriptase inhibitors and protease inhibitors, before commencing INSTI. Survival methods were used to determine time to viral suppression and treatment switch, stratified by patient treatment experience. Covariates of interest included age, gender, hepatitis B and C co-infection, previous antiretroviral treatment time, patient treatment experience and baseline viral load. Results Time to viral suppression and regimen switching from INSTI initiation was similar for second-line and highly experienced patients. The probability of achieving viral suppression at 6 months was 77.7% for second-line patients and 68.4% for highly experienced patients. There were 60 occurrences of regimen switching away from INSTI observed over 1274.0 person-years, a crude rate of 4.71 (95% CI: 3.66–6.07) per 100 person-years. Patient treatment experience was not a significant factor for regimen switch according to multivariate analysis, adjusting for relevant covariates. Conclusions We found that INSTI-based regimens were potent and durable in experienced HIV-positive patients receiving treatment outside clinical trials. These results confirm that INSTI-based regimens are a robust treatment option.

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“…Details regarding the cohort and data collected have previously been described. 12 In summary, this longitudinal observational cohort study has been ongoing since 1999, with 29 active sites contributing information for a total of 3495 enrolled participants. Core data collected includes typical patient demographics, HIV disease stage (CD4 T-cell counts, HIV viral load and AIDS defining illness), as well as antiretroviral drug treatment histories and laboratory data (including total cholesterol, high-density lipoprotein, haemoglobin, alanine transaminase and aspartate transaminase).…”

Section: Methodsmentioning

confidence: 99%

How do outcomes compare between women and men living with HIV in Australia? An observational study

Giles

Zapata

Wright³

et al. 2016

Sex. Health

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Background Gender differences vary across geographical settings and are poorly reported in the literature. The aim of this study was to evaluate demographics and clinical characteristics of participants from the Australian HIV Observational Database (AHOD), and to explore any differences between females and males in the rate of new clinical outcomes, as well as initial immunological and virological response to antiretroviral therapy. Methods Time to a new clinical end-point, all-cause mortality and/or AIDS illness was analysed using standard survival methods. Univariate and covariate adjusted Cox proportional hazard models were used to evaluate the time to plasma viral load suppression in all patients that initiated antiretroviral therapy (ART) and time to switching from a first-line ART to a second-line ART regimen. Results There was no significant difference between females and males for the hazard of all-cause mortality [adjusted hazard ratio: 0.98 (0.51, 1.55), P = 0.67], new AIDS illness [adjusted hazard ratio: 0.75 (0.38, 1.48), P = 0.41] or a composite end-point [adjusted hazard ratio: 0.74 (0.45, 1.21), P = 0.23]. Incident rates of all-cause mortality were similar between females and males; 1.14 (0.61, 1.95) vs 1.28 (1.12, 1.45) per 100 person years. Virological response to ART was similar for females and males when measured as time to viral suppression and/or time to virological failure. Conclusion This study supports current Australian HIV clinical care as providing equivalent standards of care for male and female HIV-positive patients. Future studies should compare ART-associated toxicity differences between ART-associated toxicity differences between men and women living with HIV in Australia.

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Rates of combination antiretroviral treatment change in Australia, 1997–2000

Cited by 63 publications

References 12 publications

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

Treatment durability and virological response in treatment-experienced HIV-positive patients on an integrase inhibitor-based regimen: an Australian cohort study

How do outcomes compare between women and men living with HIV in Australia? An observational study

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