Journal Article

Trends and Disparities in Antiretroviral Therapy Initiation and Virologic Suppression Among Newly Treatment-Eligible HIV-Infected Individuals in North America, 2001–2009

Horberg, Michael A., Althoff, Keri N., Gebo, Kelly A., Kitahata, Mari M., Klein, Marina B., Hanna, David B., Thorne, Jennifer E., Gill, M. John, Hessol, Nancy A., Gange, Stephen J., Moore, Richard D., Silverberg, Michael J., Samji, Hasina, Korthuis, Todd, Willig, James H., Lau, Bryan, Sterling, Timothy R., Jacobson, Lisa P., Buchacz, Kate, Napravnik, Sonia, Rourke, Sean B., Kirk, Gregory D., Crane, Heidi M., Patel, Pragna, Martin, Jeffrey N., Rodriguez, Benigno, Collier, Ann C.

2013

Overview

Background. Since the mid-1990s, effective antiretroviral therapy (ART) regimens have improved in potency, tolerability, ease of use, and class diversity. We sought to examine trends in treatment initiation and resulting human immunodeficiency virus (HIV) virologic suppression in North America between 2001 and 2009, and demographic and geographic disparities in these outcomes. Methods. We analyzed data on HIV-infected individuals newly clinically eligible for ART (ie, first reported CD4 + count <350 cells/μL or AIDS-defining illness, based on treatment guidelines during the study period) from 17 North American AIDS Cohort Collaboration on Research and Design cohorts. Outcomes included timely ART initiation (within 6 months of eligibility) and virologic suppression (≤500 copies/mL, within 1 year). We examined time trends and considered differences by geographic location, age, sex, transmission risk, race/ethnicity, CD4 + count, and viral load, and documented psychosocial barriers to ART initiation, including non—injection drug abuse, alcohol abuse, and mental illness. Results. Among 10 692 HIV-infected individuals, the cumulative incidence of 6-month ART initiation increased from 51% in 2001 to 72% in 2009 (P trend < .001). The cumulative incidence of 1-year virologic suppression increased from 55% to 81%, and among ART initiators, from 84% to 93% (both P trend < .001). A greater number of psychosocial barriers were associated with decreased ART initiation, but not virologic suppression once ART was initiated. We found significant heterogeneity by state or province of residence (P < .001). Conclusions. In the last decade, timely ART initiation and virologic suppression have greatly improved in North America concurrent with the development of better-tolerated and more potent regimens, but significant barriers to treatment uptake remain, both at the individual level and systemwide.

• Publisher: Oxford University Press
• Subject: Adolescent / Adult / AIDS / Anti-HIV Agents - therapeutic use / Antibiotics. Antiinfectious agents. Antiparasitic agents / Antiretroviral agents / Antiretroviral drugs / Antiretrovirals / Antiviral agents / Art therapy / Arts / Biological and medical sciences / Canada / Clinical outcomes / Drug abuse / Drug therapy / Female / Healthcare Disparities / Heterogeneity / HIV / HIV Infections - drug therapy / HIV Infections - virology / HIV/AIDS / Human immunodeficiency virus / Human viral diseases / Humans / Immunodeficiencies / Immunodeficiencies. Immunoglobulinopathies / Immunopathology / Incidence / Infectious diseases / Jurisdiction / Male / Medical sciences / Mental disorders / Mental health outcomes / Middle Aged / Multivariate Analysis / Pharmacology. Drug treatments / Proportional Hazards Models / Sexually transmitted diseases / STD / Treatment Outcome / United States / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / Viral Load / Virology / Young Adult