Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

• Type of Material: Article
• Authors: Vincent Marconi, Emory University; Greg A. Grandits, University of Minnesota; Amy C. Weintrob, Walter Reed Army Medical Center; Helen Chun, Naval Medical Center San Diego; Michael L. Landrum, San Antonio Military Medical Center; Anuradha Ganesan, National Naval Medical Center; Jason F. Okulicz, San Antonio Military Medical Center; Nancy Crum-Cianflone, Walter Reed Army Medical Center; Robert J. O'Connell, Walter Reed Army Institute of Research; Alan Lifson, University of Minnesota; Glenn W. Wortmann, Walter Reed Army Medical Center; Brian K. Agan, Uniformed Services University of the Health Sciences
• Language: English
• Date: 2010-05-27
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2010 Marconi et al; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.aidsrestherapy.com/content/7/1/14
• Title of Journal or Parent Work: AIDS Research and Therapy
• ISSN: 1742-6405
• Volume: 7
• Issue: 14
• Start Page: 1
• End Page: 10
• Grant/Funding Information: Support for this work (IDCRP-000-03) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences.; This support included study design, data collection, analysis, data interpretation, manuscript writing, and submission.; This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.
• Research Categories: Health Sciences, Epidemiology

Abstract

Background: To examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007. Methods: Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes. Results: Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF. Conclusions: In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.