Usefulness of an observational database to assess antiretroviral treatment trends in India.
BACKGROUND
Human immunodeficiency virus (HIV) observational cohorts, which are established worldwide, support comparative studies across different regions. They have played an important role in developing international and country-specific HIV treatment and care guidelines. We describe the YRG CARE Chennai HIV observation database (YCHOD) and highlight its utility in monitoring trends in antiretroviral treatment use and HIV disease outcomes in India.


METHODS
The baseline characteristics, time trends in antiretroviral treatment, trends in incidence of acquired immune deficiency syndrome (AIDS)-defining illness and mortality following the introduction of highly active antiretroviral therapy (HAART) in India were assessed using YCHOD.


RESULTS
Till January 2005, 7647 HIV-positive patients had registered in YCHOD. A majority of the patients were men (69%) and had a mean age of 32 years. At baseline, 14% had an existing AIDS-defining illness. Among patients who required therapy by the WHO criteria, 14% initiated antiretroviral therapy (ART) in 1996 and 35% in 2000. Since the dramatic cost reduction of generic HAART in 2001, there has been an increase in the proportion of patients receiving ART to 57% in 2004. In patients who were started on HAART, the incidence of at least one AIDS-defining illness was 2% in 2001, and this decreased to 0.48% in 2004.


CONCLUSIONS
We feel observational cohorts are useful as a surveillance tool for monitoring trends in treatment and disease progression. Standardized observational data collected systematically on HIV-infected individuals will help to assess the cost-effectiveness of ART and in planning ART strategies for India.
YR Gaitonde Cente for AIDS Research and Education, Chennai, Tamil Nadu, India.
A J
AJ
Cecelia
P
P
Christybai
S
S
Anand
K
K
Jayakumar
T
T
Gurunathan
P
P
Vidya
S
S
Solomon
N
N
Kumarasamy
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D019992:Databases as Topic; D018450:Disease Progression; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006782:Hospitals, Special; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019370:Observation; D011159:Population Surveillance / Q000379:methods; D040442:Public Health Informatics; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents