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Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort.
- Source :
-
HIV Medicine . Jul2011, Vol. 12 Issue 6, p352-360. 9p. - Publication Year :
- 2011
-
Abstract
- Objective The aim of the study was to evaluate time to virological suppression in a cohort of individuals who started highly active antiretroviral therapy (HAART), and to explore the factors associated with suppression. Methods Eligible participants were HIV-positive individuals from a multi-site Canadian cohort of antiretroviral-naïve patients initiating HAART on or after 1 January 2000. Viral load and CD4 measurements within 6 months prior to HAART initiation were assessed. Univariate and multivariate analyses were conducted using piecewise survival exponential models where time scale was divided into intervals (<10 months; ⩾10 months). Virological suppression was defined as the time to the first of at least two consecutive viral load measurements <50 HIV-1 RNA copies/mL. Results A total of 3555 individuals were included in the study, of median age 40 years [interquartile range (IQR) 34-47 years]. Eighty per cent were male, 18% had a history of injecting drug use (IDU), and 13% presented with an AIDS-defining illness at baseline. The median time to suppression was 4.55 months (IQR 2.99-7.89 months). In multivariate analyses, older age, male sex, treatment in Ontario rather than British Columbia, non-IDU history, and having an AIDS diagnosis at baseline predicted increased likelihood of suppression. Patients with low baseline viral load were more likely to have suppression [4-5 log10 copies/mL, hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.18-1.38; <4 log10 copies/mL, HR 1.49, 95% CI 1.32-1.68] than patients with baseline viral load ⩾5 log10 copies/mL; however, this effect ceased after 18 months of follow-up. Suppression was more likely with nonnucleoside reverse transcriptase inhibitors and ritonavir-boosted HAART. Conclusion Identification of patients at risk for diminished likelihood of virological suppression will allow focusing of efforts and the utilization of resources to maximize the benefits of HAART. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HIV infection prognosis
*AGE distribution
*BLOOD cell count
*CHI-squared test
*COMPUTER software
*CONFIDENCE intervals
*STATISTICAL correlation
*FISHER exact test
*HIV infections
*LONGITUDINAL method
*MEDICAL cooperation
*MULTIVARIATE analysis
*HEALTH outcome assessment
*POPULATION geography
*REGRESSION analysis
*RESEARCH
*RESEARCH funding
*SEX distribution
*STATISTICAL hypothesis testing
*STATISTICS
*SURVIVAL analysis (Biometry)
*T cells
*TIME
*DATA analysis
*VIRAL load
*HIGHLY active antiretroviral therapy
*TREATMENT effectiveness
Subjects
Details
- Language :
- English
- ISSN :
- 14642662
- Volume :
- 12
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- HIV Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 60959970
- Full Text :
- https://doi.org/10.1111/j.1468-1293.2010.00890.x