title: U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000 to 2008.
abstract: BACKGROUND
  The U.S. National HIV/AIDS Strategy targets for 2015 include "increasing access to care and improving health outcomes for persons living with HIV in the United States" (PLWH-US).
  
  
  OBJECTIVE
  To demonstrate the utility of the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) for monitoring trends in the HIV epidemic in the United States and to present trends in HIV treatment and related health outcomes.
  
  
  METHODS
  Trends from annual cross-sectional analyses comparing patients from pooled, multicenter, prospective, clinical HIV cohort studies with PLWH-US, as reported to national surveillance systems in 40 states.
  
  
  METHODS
  U.S. HIV outpatient clinics.
  
  
  METHODS
  HIV-infected adults with 1 or more HIV RNA plasma viral load (HIV VL) or CD4 T-lymphocyte (CD4) cell count measured in any calendar year from 1 January 2000 to 31 December 2008.
  
  
  METHODS
  Annual rates of antiretroviral therapy use, HIV VL, and CD4 cell count at death.
  
  
  RESULTS
  45 529 HIV-infected persons received care in an NA-ACCORD-participating U.S. clinical cohort from 2000 to 2008. In 2008, the 26 030 NA-ACCORD participants in care and the 655 966 PLWH-US had qualitatively similar demographic characteristics. From 2000 to 2008, the proportion of participants prescribed highly active antiretroviral therapy increased by 9 percentage points to 83% (P < 0.001), whereas the proportion with suppressed HIV VL (≤2.7 log10 copies/mL) increased by 26 percentage points to 72% (P < 0.001). Median CD4 cell count at death more than tripled to 0.209 × 109 cells/L (P < 0.001).
  
  
  CONCLUSIONS
  The usual limitations of observational data apply.
  
  
  CONCLUSIONS
  The NA-ACCORD is the largest cohort of HIV-infected adults in clinical care in the United States that is demographically similar to PLWH-US in 2008. From 2000 to 2008, increases were observed in the percentage of prescribed HAART, the percentage who achieved a suppressed HIV VL, and the median CD4 cell count at death.
  
  
  BACKGROUND
  National Institutes of Health; Centers for Disease Control and Prevention; Canadian Institutes of Health Research; Canadian HIV Trials Network; and the government of British Columbia, Canada.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA. kalthoff@jhsph.edu
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
authors.forename: Jinbing
authors.initials: J
authors.lastname: Zhang
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.forename: Peter
authors.initials: P
authors.lastname: Rebeiro
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Martin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Angela
authors.initials: A
authors.lastname: Cescon
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral