title: Clinical course and quality of care in ART-naïve patients newly presenting in a HIV outpatient clinic.
abstract: OBJECTIVE
  Little data exist about the quality of care for HIV-infected subjects in Germany. We investigated the clinical course of HIV-infected subjects newly presenting in our HIV outpatient clinic.
  
  
  METHODS
  Antiretroviral therapy (ART)-naïve HIV-infected subjects presenting between 2007 and 2008 were followed until June 2012. Clinical data and laboratory parameters were collected prospectively and analysed retrospectively.
  
  
  RESULTS
  From 281 subjects included, 34 patients (12%) were lost to follow-up. 247 subjects remained, and 171 patients were followed for 1,497 days [1,121/1,726] (all data: median [interquartile range]). ART was started in 199 patients (81%) 182 days [44/849] after HIV diagnosis, and all patients were treated according to European guidelines or within clinical trials. The CD4 cell count at first presentation was 320/µL [160/500] and declined to 210/µL [100/300] at ART start. 12 months thereafter, the CD4 cell count increased to 410/µL [230/545]. The HIV RNA was suppressed below 50 copies/mL after 108 days [63/173] in 182 patients (91%). Initial ART was changed in 71 patients (36%) after 281 days [99/718], in five patients (7%) due to virological failure, in 66 patients (93%) due to other reasons, e.g. side effects or patient's request.
  
  
  CONCLUSIONS
  Two-thirds of the included patients were followed for more than 3 years, and ART was initiated in 81% of the patients leading to complete virological suppression in most patients. Compliance of physicians with treatment guidelines was high. Late presentation with a severely compromised immune function remains a problem and impairs the otherwise good prognosis of HIV infection.
authors: Department of Internal Medicine I, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany, martin.platten@uk-koeln.de.
authors: M
authors: M
authors: Platten
authors: R
authors: R
authors: Linnemann
authors: T
authors: T
authors: Kümmerle
authors: N
authors: N
authors: Jung
authors: C
authors: C
authors: Wyen
authors: K
authors: K
authors: Ehren
authors: S
authors: S
authors: Gravemann
authors: D
authors: D
authors: Gillor
authors: O A
authors: OA
authors: Cornely
authors: J
authors: J
authors: Fischer
authors: C
authors: C
authors: Lehmann
authors: J K
authors: JK
authors: Rockstroh
authors: G
authors: G
authors: Fätkenheuer
authors: J J
authors: JJ
authors: Vehreschild
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002983:Clinical Competence; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006678:HIV / Q000276:immunology / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D061665:Time-to-Treatment
chemical_list: D019380:Anti-HIV Agents