title: Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009.
abstract: BACKGROUND
  Since the mid-1990s, effective antiretroviral therapy (ART) regimens have improved in potency, tolerability, ease of use, and class diversity. We sought to examine trends in treatment initiation and resulting human immunodeficiency virus (HIV) virologic suppression in North America between 2001 and 2009, and demographic and geographic disparities in these outcomes.
  
  
  METHODS
  We analyzed data on HIV-infected individuals newly clinically eligible for ART (ie, first reported CD4+ count<350 cells/µL or AIDS-defining illness, based on treatment guidelines during the study period) from 17 North American AIDS Cohort Collaboration on Research and Design cohorts. Outcomes included timely ART initiation (within 6 months of eligibility) and virologic suppression (≤500 copies/mL, within 1 year). We examined time trends and considered differences by geographic location, age, sex, transmission risk, race/ethnicity, CD4+ count, and viral load, and documented psychosocial barriers to ART initiation, including non-injection drug abuse, alcohol abuse, and mental illness.
  
  
  RESULTS
  Among 10,692 HIV-infected individuals, the cumulative incidence of 6-month ART initiation increased from 51% in 2001 to 72% in 2009 (Ptrend<.001). The cumulative incidence of 1-year virologic suppression increased from 55% to 81%, and among ART initiators, from 84% to 93% (both Ptrend<.001). A greater number of psychosocial barriers were associated with decreased ART initiation, but not virologic suppression once ART was initiated. We found significant heterogeneity by state or province of residence (P<.001).
  
  
  CONCLUSIONS
  In the last decade, timely ART initiation and virologic suppression have greatly improved in North America concurrent with the development of better-tolerated and more potent regimens, but significant barriers to treatment uptake remain, both at the individual level and systemwide.
authors: Johns Hopkins University, Baltimore, Maryland, USA. david.hanna@einstein.yu.edu
authors: David B
authors: DB
authors: Hanna
authors: Kate
authors: K
authors: Buchacz
authors: Kelly A
authors: KA
authors: Gebo
authors: Nancy A
authors: NA
authors: Hessol
authors: Michael A
authors: MA
authors: Horberg
authors: Lisa P
authors: LP
authors: Jacobson
authors: Gregory D
authors: GD
authors: Kirk
authors: Mari M
authors: MM
authors: Kitahata
authors: P Todd
authors: PT
authors: Korthuis
authors: Richard D
authors: RD
authors: Moore
authors: Sonia
authors: S
authors: Napravnik
authors: Pragna
authors: P
authors: Patel
authors: Michael J
authors: MJ
authors: Silverberg
authors: Timothy R
authors: TR
authors: Sterling
authors: James H
authors: JH
authors: Willig
authors: Bryan
authors: B
authors: Lau
authors: Keri N
authors: KN
authors: Althoff
authors: Heidi M
authors: HM
authors: Crane
authors: Ann C
authors: AC
authors: Collier
authors: Hasina
authors: H
authors: Samji
authors: Jennifer E
authors: JE
authors: Thorne
authors: M John
authors: MJ
authors: Gill
authors: Marina B
authors: MB
authors: Klein
authors: Jeffrey N
authors: JN
authors: Martin
authors: Benigno
authors: B
authors: Rodriguez
authors: Sean B
authors: SB
authors: Rourke
authors: Stephen J
authors: SJ
authors: Gange
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents