477-M. Recent Trends in Treatment Use and Virological Suppression in a London HIV Clinic Population

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Session 67 Poster Session
Disease Progression/Effects of Treatment
Session Time: 4:30-6:30 pm
Room 4E-F

477-M.

Recent Trends in Treatment Use and Virological Suppression in a London HIV Clinic Population
F. Lampe*, M. A. Johnson, C. Loveday, C. Chaloner, C. Sabin, M. Youle, S. Kinloch, S. Madge, and A. N. Phillips
Royal Free Centre for HIV Med., London, UK

Background: Introduction of HAART has transformed HIV treatment, but there is concern regarding the feasibility of its long-term use. We examined trends in treatment use and virological suppression among the HIV clinic population at the Royal Free Hospital, London, from 1999 to 2001, a period in which HAART has been the standard of care.
Methods: Antiretroviral treatment (ART) use, viral load (VL) and CD4 count were ascertained at 5 half-yearly time points (from January 1999 to January 2001) for patients under follow-up on each occasion. Statistical tests for trend over the 2-year period were performed using logistic generalized estimating equations.
Results: The number of patients under follow-up at each time point ranged from 1116 to 1207. The percentage of patients taking ART rose from 58% in January 1999 to 69% in January 2001. Of all treated patients, the percentage taking >=3 drugs (HAART) increased from 89.2% to 96.8%; NNRTI use increased from 28.6% to 43.6%, while protease inhibitor use fell from 70.3% to 59.7%, and use of >= 4 drugs rose from 24.1% to 35.6%. Among HAART treated patients, median time on HAART doubled (from 13 to 26 months) over the 2 years. By January 2001, 23% of all patients had been exposed to all 3 drug classes. Over the 2-year period, the proportion of patients with viral suppression (VL <400 copies/mL) rose from 70.3% to 84.3% among all treated patients (p<0.001 for trend), and from 74.5% to 85.9% among patients on HAART (p<0.001). Trends in VL <50 copies/mL were assessed using the last 3 time points only (January 2000 to January 2001). Over this 12-month period, the proportion with VL <50 copies/mL rose from 66.3% to 70.9% among all treated patients (p=0.001), and from 69.1% to 72.6% among HAART treated patients (p=0.004). Of patients on HAART for >= 30 weeks, VL was < 50 copies/mL in 75.9%, 73.8% and 78.3% in January 2000, July 2000 and January 2001 respectively (p=0.22). Overall, the median CD4 count increased from 358 /mm³ in January 1999 to 449 /mm³ in January 2001, the prevalence of low CD4 (<50 /mm³) fell from 4.9% to 2.4% (p<0.001), and the rate of new AIDS events declined from 5.6 to 2.0 per 100 person-years.
Conclusions: The virological and immunological profile of HIV infected patients under care has continued to improve over the last 2 years. Increases in duration of HAART use and likelihood of exposure to all drug classes have not yet had an adverse impact on response to therapy at a population level.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections