Trends over calendar time in antiretroviral treatment success and failure in HIV clinic populations.
OBJECTIVE
Effective antiretroviral therapy (ART) has transformed the care of people with HIV, but it is important to monitor time trends in indicators of treatment success and antic future changes.


METHODS
We assessed time trends from 2000 to 2007 in several indicators of treatment success in the UK Collaborative HIV Cohort (CHIC) Study, and using national HIV data from the Health Protection Agency (HPA) we developed a model to project future trends.


RESULTS
The proportion of patients on ART with a viral load <50 HIV-1 RNA copies/mL increased from 62% in 2000 to 84% in 2007, and the proportion of all patients with a CD4 count <200 cells/microL decreased from 21% to 10%. During this period, the number of patients who experienced extensive triple class failure (ETCF) rose from 147 (0.9%) to 1771 (3.9%). The number who experienced such ETCF and had a current viral load >50 copies/mL rose fromz 118 (0.7%) to 857 (1.9%). Projections to 2012 suggest sustained high levels of success, with a continued increase in the number of patients who have failed multiple drugs but a relatively stable number of such patients experiencing viral loads >50 copies/mL. Numbers of deaths are projected to remain low.


CONCLUSIONS
There have been continued improvements in key indicators of success in patients with HIV from 2000 to 2007. Although the number of patients who have ETCF is projected to rise in the future, the number of such patients with viral loads >50 copies/mL is not projected to increase up to 2012. New drugs may be needed in future to sustain these positive trends.
UCL Medical School, Royal Free Campus, London, UK. l.bansi@pcps.ucl.ac.uk
L
L
Bansi
C
C
Sabin
V
V
Delpech
T
T
Hill
M
M
Fisher
J
J
Walsh
T
T
Chadborn
P
P
Easterbrook
R
R
Gilson
M
M
Johnson
K
K
Porter
J
J
Anderson
M
M
Gompels
C
C
Leen
J
J
Ainsworth
C
C
Orkin
M
M
Nelson
B
B
Rice
A
A
Phillips
D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000639:trends*; D015331:Cohort Studies; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010043:Outcome and Process Assessment, Health Care; D013269:Stochastic Processes; D013997:Time Factors; D017211:Treatment Failure; D006113:United Kingdom; D019562:Viral Load
D019380:Anti-HIV Agents