Temporal trends of time to antiretroviral treatment initiation, interruption and modification: Examination of patients diagnosed with advanced HIV in Australia

Stephen T. Wright, Matthew G. Law, David A. Cooper, Phillip Keen, Ann McDonald, Melanie Middleton, Ian Woolley, Mark Kelly, Kathy Petoumenos, D. Ellis, M. Bloch, S. Agrawal, T. Vincent, D. Allen, J. L. Little, D. Smith, C. Mincham, D. Baker, V. Ieroklis, D. J. TempletonC. C. O'Connor, S. Phan, E. Jackson, K. McCallum, M. Grotowski, S. Taylor, A. Carr, F. Lee, K. Hesse, K. Sinn, R. Norris, R. Finlayson, I. Prone, A. Patel, R. Varma, J. Shakeshaft, K. Brown, C. McGrath, S. Halligan, L. Wray, P. Read, H. Lu, D. Couldwell, V. Furner, S. Fernando, J. Chuah, J. Watson, C. Lawrence, B. Mulhall, H. McManus, C. Bendall, M. Boyd, N. Ryder, R. Payne, D. Russell, S. Doyle-Adams, D. Sowden, K. Taing, K. McGill, D. Orth, D. Youds, A. Gibson, H. Magon, B. Dickson, W. Donohue, R. Moore, S. Edwards, R. Liddle, P. Locke, N. J. Roth, H. Lau, T. Read, J. Silvers, W. Zeng, J. Hoy, K. Watson, M. Bryant, S. Price, M. Giles, J. Hoy, J. Williams, D. Nolan, J. Robinson, K. Morwood, N. Roth, K. Choong, M. A. Boyd, P. C.K. Li, M. P. Lee, S. Vanar, S. Faridah, A. Kamarulzaman, J. Y. Choi, B. Vannary, R. Ditangco, K. Tsukada, S. Pujari, A. Makane, O. T. Ng, A. J. Sasisopin

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Methods: We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis.We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Results: Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Conclusions: Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods.We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.:

Original languageEnglish
Article number19463
JournalJournal of the International AIDS Society
Volume18
Issue number1
DOIs
Publication statusPublished - 2015 Apr 10

Fingerprint

HIV
Therapeutics
CD4 Lymphocyte Count
Viral Load
Heterosexuality
Proxy
Proportional Hazards Models
Registries
Logistic Models
Databases
RNA
Survival

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Wright, Stephen T. ; Law, Matthew G. ; Cooper, David A. ; Keen, Phillip ; McDonald, Ann ; Middleton, Melanie ; Woolley, Ian ; Kelly, Mark ; Petoumenos, Kathy ; Ellis, D. ; Bloch, M. ; Agrawal, S. ; Vincent, T. ; Allen, D. ; Little, J. L. ; Smith, D. ; Mincham, C. ; Baker, D. ; Ieroklis, V. ; Templeton, D. J. ; O'Connor, C. C. ; Phan, S. ; Jackson, E. ; McCallum, K. ; Grotowski, M. ; Taylor, S. ; Carr, A. ; Lee, F. ; Hesse, K. ; Sinn, K. ; Norris, R. ; Finlayson, R. ; Prone, I. ; Patel, A. ; Varma, R. ; Shakeshaft, J. ; Brown, K. ; McGrath, C. ; Halligan, S. ; Wray, L. ; Read, P. ; Lu, H. ; Couldwell, D. ; Furner, V. ; Fernando, S. ; Chuah, J. ; Watson, J. ; Lawrence, C. ; Mulhall, B. ; McManus, H. ; Bendall, C. ; Boyd, M. ; Ryder, N. ; Payne, R. ; Russell, D. ; Doyle-Adams, S. ; Sowden, D. ; Taing, K. ; McGill, K. ; Orth, D. ; Youds, D. ; Gibson, A. ; Magon, H. ; Dickson, B. ; Donohue, W. ; Moore, R. ; Edwards, S. ; Liddle, R. ; Locke, P. ; Roth, N. J. ; Lau, H. ; Read, T. ; Silvers, J. ; Zeng, W. ; Hoy, J. ; Watson, K. ; Bryant, M. ; Price, S. ; Giles, M. ; Hoy, J. ; Williams, J. ; Nolan, D. ; Robinson, J. ; Morwood, K. ; Roth, N. ; Choong, K. ; Boyd, M. A. ; Li, P. C.K. ; Lee, M. P. ; Vanar, S. ; Faridah, S. ; Kamarulzaman, A. ; Choi, J. Y. ; Vannary, B. ; Ditangco, R. ; Tsukada, K. ; Pujari, S. ; Makane, A. ; Ng, O. T. ; Sasisopin, A. J. / Temporal trends of time to antiretroviral treatment initiation, interruption and modification : Examination of patients diagnosed with advanced HIV in Australia. In: Journal of the International AIDS Society. 2015 ; Vol. 18, No. 1.
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title = "Temporal trends of time to antiretroviral treatment initiation, interruption and modification: Examination of patients diagnosed with advanced HIV in Australia",
abstract = "Introduction: HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment na{\"i}ve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Methods: We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis.We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Results: Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83{\%} (69, 91{\%}) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Conclusions: Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods.We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.:",
author = "Wright, {Stephen T.} and Law, {Matthew G.} and Cooper, {David A.} and Phillip Keen and Ann McDonald and Melanie Middleton and Ian Woolley and Mark Kelly and Kathy Petoumenos and D. Ellis and M. Bloch and S. Agrawal and T. Vincent and D. Allen and Little, {J. L.} and D. Smith and C. Mincham and D. Baker and V. Ieroklis and Templeton, {D. J.} and O'Connor, {C. C.} and S. Phan and E. Jackson and K. McCallum and M. Grotowski and S. Taylor and A. Carr and F. Lee and K. Hesse and K. Sinn and R. Norris and R. Finlayson and I. Prone and A. Patel and R. Varma and J. Shakeshaft and K. Brown and C. McGrath and S. Halligan and L. Wray and P. Read and H. Lu and D. Couldwell and V. Furner and S. Fernando and J. Chuah and J. Watson and C. Lawrence and B. Mulhall and H. McManus and C. Bendall and M. Boyd and N. Ryder and R. Payne and D. Russell and S. Doyle-Adams and D. Sowden and K. Taing and K. McGill and D. Orth and D. Youds and A. Gibson and H. Magon and B. Dickson and W. Donohue and R. Moore and S. Edwards and R. Liddle and P. Locke and Roth, {N. J.} and H. Lau and T. Read and J. Silvers and W. Zeng and J. Hoy and K. Watson and M. Bryant and S. Price and M. Giles and J. Hoy and J. Williams and D. Nolan and J. Robinson and K. Morwood and N. Roth and K. Choong and Boyd, {M. A.} and Li, {P. C.K.} and Lee, {M. P.} and S. Vanar and S. Faridah and A. Kamarulzaman and Choi, {J. Y.} and B. Vannary and R. Ditangco and K. Tsukada and S. Pujari and A. Makane and Ng, {O. T.} and Sasisopin, {A. J.}",
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language = "English",
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Wright, ST, Law, MG, Cooper, DA, Keen, P, McDonald, A, Middleton, M, Woolley, I, Kelly, M, Petoumenos, K, Ellis, D, Bloch, M, Agrawal, S, Vincent, T, Allen, D, Little, JL, Smith, D, Mincham, C, Baker, D, Ieroklis, V, Templeton, DJ, O'Connor, CC, Phan, S, Jackson, E, McCallum, K, Grotowski, M, Taylor, S, Carr, A, Lee, F, Hesse, K, Sinn, K, Norris, R, Finlayson, R, Prone, I, Patel, A, Varma, R, Shakeshaft, J, Brown, K, McGrath, C, Halligan, S, Wray, L, Read, P, Lu, H, Couldwell, D, Furner, V, Fernando, S, Chuah, J, Watson, J, Lawrence, C, Mulhall, B, McManus, H, Bendall, C, Boyd, M, Ryder, N, Payne, R, Russell, D, Doyle-Adams, S, Sowden, D, Taing, K, McGill, K, Orth, D, Youds, D, Gibson, A, Magon, H, Dickson, B, Donohue, W, Moore, R, Edwards, S, Liddle, R, Locke, P, Roth, NJ, Lau, H, Read, T, Silvers, J, Zeng, W, Hoy, J, Watson, K, Bryant, M, Price, S, Giles, M, Hoy, J, Williams, J, Nolan, D, Robinson, J, Morwood, K, Roth, N, Choong, K, Boyd, MA, Li, PCK, Lee, MP, Vanar, S, Faridah, S, Kamarulzaman, A, Choi, JY, Vannary, B, Ditangco, R, Tsukada, K, Pujari, S, Makane, A, Ng, OT & Sasisopin, AJ 2015, 'Temporal trends of time to antiretroviral treatment initiation, interruption and modification: Examination of patients diagnosed with advanced HIV in Australia', Journal of the International AIDS Society, vol. 18, no. 1, 19463. https://doi.org/10.7448/IAS.18.1.19463

Temporal trends of time to antiretroviral treatment initiation, interruption and modification : Examination of patients diagnosed with advanced HIV in Australia. / Wright, Stephen T.; Law, Matthew G.; Cooper, David A.; Keen, Phillip; McDonald, Ann; Middleton, Melanie; Woolley, Ian; Kelly, Mark; Petoumenos, Kathy; Ellis, D.; Bloch, M.; Agrawal, S.; Vincent, T.; Allen, D.; Little, J. L.; Smith, D.; Mincham, C.; Baker, D.; Ieroklis, V.; Templeton, D. J.; O'Connor, C. C.; Phan, S.; Jackson, E.; McCallum, K.; Grotowski, M.; Taylor, S.; Carr, A.; Lee, F.; Hesse, K.; Sinn, K.; Norris, R.; Finlayson, R.; Prone, I.; Patel, A.; Varma, R.; Shakeshaft, J.; Brown, K.; McGrath, C.; Halligan, S.; Wray, L.; Read, P.; Lu, H.; Couldwell, D.; Furner, V.; Fernando, S.; Chuah, J.; Watson, J.; Lawrence, C.; Mulhall, B.; McManus, H.; Bendall, C.; Boyd, M.; Ryder, N.; Payne, R.; Russell, D.; Doyle-Adams, S.; Sowden, D.; Taing, K.; McGill, K.; Orth, D.; Youds, D.; Gibson, A.; Magon, H.; Dickson, B.; Donohue, W.; Moore, R.; Edwards, S.; Liddle, R.; Locke, P.; Roth, N. J.; Lau, H.; Read, T.; Silvers, J.; Zeng, W.; Hoy, J.; Watson, K.; Bryant, M.; Price, S.; Giles, M.; Hoy, J.; Williams, J.; Nolan, D.; Robinson, J.; Morwood, K.; Roth, N.; Choong, K.; Boyd, M. A.; Li, P. C.K.; Lee, M. P.; Vanar, S.; Faridah, S.; Kamarulzaman, A.; Choi, J. Y.; Vannary, B.; Ditangco, R.; Tsukada, K.; Pujari, S.; Makane, A.; Ng, O. T.; Sasisopin, A. J.

In: Journal of the International AIDS Society, Vol. 18, No. 1, 19463, 10.04.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Temporal trends of time to antiretroviral treatment initiation, interruption and modification

T2 - Examination of patients diagnosed with advanced HIV in Australia

AU - Wright, Stephen T.

AU - Law, Matthew G.

AU - Cooper, David A.

AU - Keen, Phillip

AU - McDonald, Ann

AU - Middleton, Melanie

AU - Woolley, Ian

AU - Kelly, Mark

AU - Petoumenos, Kathy

AU - Ellis, D.

AU - Bloch, M.

AU - Agrawal, S.

AU - Vincent, T.

AU - Allen, D.

AU - Little, J. L.

AU - Smith, D.

AU - Mincham, C.

AU - Baker, D.

AU - Ieroklis, V.

AU - Templeton, D. J.

AU - O'Connor, C. C.

AU - Phan, S.

AU - Jackson, E.

AU - McCallum, K.

AU - Grotowski, M.

AU - Taylor, S.

AU - Carr, A.

AU - Lee, F.

AU - Hesse, K.

AU - Sinn, K.

AU - Norris, R.

AU - Finlayson, R.

AU - Prone, I.

AU - Patel, A.

AU - Varma, R.

AU - Shakeshaft, J.

AU - Brown, K.

AU - McGrath, C.

AU - Halligan, S.

AU - Wray, L.

AU - Read, P.

AU - Lu, H.

AU - Couldwell, D.

AU - Furner, V.

AU - Fernando, S.

AU - Chuah, J.

AU - Watson, J.

AU - Lawrence, C.

AU - Mulhall, B.

AU - McManus, H.

AU - Bendall, C.

AU - Boyd, M.

AU - Ryder, N.

AU - Payne, R.

AU - Russell, D.

AU - Doyle-Adams, S.

AU - Sowden, D.

AU - Taing, K.

AU - McGill, K.

AU - Orth, D.

AU - Youds, D.

AU - Gibson, A.

AU - Magon, H.

AU - Dickson, B.

AU - Donohue, W.

AU - Moore, R.

AU - Edwards, S.

AU - Liddle, R.

AU - Locke, P.

AU - Roth, N. J.

AU - Lau, H.

AU - Read, T.

AU - Silvers, J.

AU - Zeng, W.

AU - Hoy, J.

AU - Watson, K.

AU - Bryant, M.

AU - Price, S.

AU - Giles, M.

AU - Hoy, J.

AU - Williams, J.

AU - Nolan, D.

AU - Robinson, J.

AU - Morwood, K.

AU - Roth, N.

AU - Choong, K.

AU - Boyd, M. A.

AU - Li, P. C.K.

AU - Lee, M. P.

AU - Vanar, S.

AU - Faridah, S.

AU - Kamarulzaman, A.

AU - Choi, J. Y.

AU - Vannary, B.

AU - Ditangco, R.

AU - Tsukada, K.

AU - Pujari, S.

AU - Makane, A.

AU - Ng, O. T.

AU - Sasisopin, A. J.

PY - 2015/4/10

Y1 - 2015/4/10

N2 - Introduction: HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Methods: We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis.We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Results: Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Conclusions: Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods.We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.:

AB - Introduction: HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Methods: We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis.We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Results: Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Conclusions: Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods.We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.:

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U2 - 10.7448/IAS.18.1.19463

DO - 10.7448/IAS.18.1.19463

M3 - Article

C2 - 25865372

AN - SCOPUS:84927595526

VL - 18

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

IS - 1

M1 - 19463

ER -