title: A comparison of HAART outcomes between the US military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS).
abstract: BACKGROUND
  The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence.
  
  
  METHODS
  Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event.
  
  
  RESULTS
  Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables.
  
  
  CONCLUSIONS
  We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.
authors: Atlanta VA Medical Center, Atlanta, Georgia, USA. Jodie.Guest@va.gov
authors: Jodie L
authors: JL
authors: Guest
authors: Amy C
authors: AC
authors: Weintrob
authors: David
authors: D
authors: Rimland
authors: Christopher
authors: C
authors: Rentsch
authors: William P
authors: WP
authors: Bradley
authors: Brian K
authors: BK
authors: Agan
authors: Vincent C
authors: VC
authors: Marconi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014728:Veterans; D058014:Veterans Health; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
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