Clinical audit: virological and immunological response to  combination antiretroviral therapy in HIV patients at  a Sydney sexual health clinic.
OBJECTIVE
Bigge Park Centre (BPC) is a sexual health clinic located in a socially disadvantaged area in Southwest Sydney. This served as a retrospective clinical audit, documenting patient demographics, identifying factors associated with virological, immunological and discordant responses, evaluating the centre's ability in HIV control and investigating changes in practice from 1996 to 2007.


METHODS
Data including age, gender, ethnicity, mode of transmission, hepatitis co-infection, prior acquired immune deficiency syndrome (AIDS)-defining-illness, HIV-1 RNA and CD4+cell counts of patients on combination antiretroviral therapy (CART) for treatment of HIV with at least 1-year follow up at the BPC were analysed. Results were compared with other cohorts in medical literature.


RESULTS
BPC manages HIV patients from diverse backgrounds. Sequential monotherapy was associated with poor virological control, lower CD4+cell recovery and discordant response. When patients who had sequential monotherapy were excluded, Caucasian race, high viral load at 1 month and triple-NRTI (nucleoside reverse transcriptase inhibitor) regimen were associated with lack of virological control. Lower baseline viral load and triple-NRTI regimen were associated with lower CD4+cell recovery. Lower baseline CD4+cell count and prior diagnosis of AIDS were associated with discordant response. Virological control and CD4+cell recovery achieved were comparable to that documented in medical literature. There was no significant change over time in terms of timing of CART initiation, attainment of immunological response or virological control since the late 1990 s.


CONCLUSIONS
HIV control achieved at the BPC was comparable to that reported in medical literature. Enhancement of strategies to promote screening and improve adherence as well as performance of HIV resistance assessment and avoidance of triple-NRTI therapy will likely improve patient care.
Hsu
D C
DC
Sydney South West Area Health Service, Department of Immunology, Royal Prince Alfred Hospital, Camperdown, Australia. denise.hsu@sswahs.nsw.gov.au
Quin
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015704:CD4 Antigens / Q000276:immunology; D054869:Clinical Audit / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D019562:Viral Load / Q000276:immunology; D055815:Young Adult
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D015704:CD4 Antigens