Background:  Early studies indicated that only ~50% of patients receiving HAART in clinical practice had virologic suppression. HAART utilization has evolved since 1996. We sought to determine how virologic and other outcomes of HAART use have changed in clinical practice since 1996.

Methods:  We assessed the virologic, immunologic, and clinical response to an initial HAART regimen started in 1996-2002 in a cohort of HIV-infected patients in longitudinal HIV care in Maryland. We compared all patients who started their first HAART regimen from 1996 to 2002, and were followed at least 1 year (or until death if <1 year). Outcomes included undetectable HIV-1 RNA (<400 copies/mL) by 6 and 12 months; change in CD4 from baseline at 6 and 12 months, development of AIDS-defining illness, and death.

Results:  Characteristics of patients at initial HAART that changed over time included increase in African American race (1996: 64%, 2002: 74%), female (1996: 24%, 2002: 40%), and prior NRTI use (1996: 88%, 2002: 65%), but not injecting drug use (IDU) risk (46%), CD4 (median = 190 cells), or HIV-1 RNA (median = 71,000 copies/mL). There were significant changes in HAART regimen.