title: Significant reduction in HIV virologic failure during a 15-year period in a setting with free healthcare access.
abstract: BACKGROUND
  Calendar trends in virologic failure (VF) among human immunodeficiency virus (HIV)-infected patients can help to evaluate the performance of healthcare systems and the need for new antiretroviral therapy (ART). We examined the time trend in the rate of VF beyond 6 months of ART between 1997 and 2011 in France.
  
  
  METHODS
  We included patients from the French Hospital Database on HIV who received at least 6 months of ART. VF was defined as 2 consecutive plasma HIV-RNA values >500 copies/mL or as 1 value >500 copies/mL followed by a treatment switch. We adjusted for patients' characteristics by fitting a multivariable generalized estimating equation logistic regression model with an exchangeable covariance matrix.
  
  
  RESULTS
  A total of 81 738 patients were enrolled, and median follow-up was 112.4 months. Median CD4 count was 333 cells/µL, and 23% of patients had HIV infection classified as Centers for Disease Control and Prevention stage C. Overall, 29.3% of patients received single/dual-drug ART initially, and 45.4% of patients experienced at least 1 episode of VF during follow-up. The percentage of patients with VF fell from 61.5% in 1997-1998 to 9.7% in 2009-2011 (P < .0001). Factors associated with the lower frequency of VF were recent calendar period, a higher contemporary CD4 cell count, and first-line regimens based on nonnucleoside reverse transcriptase inhibitors or integrase inhibitors.
  
  
  CONCLUSIONS
  The proportion of HIV-infected patients experiencing VF during routine care fell markedly between 1997 and 2009-2011, to only 9.7%. This was attributed to the advent of fully active and better-tolerated antiretroviral drugs, and to national guidelines recommending rapid management of VF after mid-2000.
authors.affiliation: INSERM, U941 Université Paris Diderot, Sorbonne Paris Cité AP-HP, Virology, Saint-Louis Hospital.
authors.forename: Constance
authors.initials: C
authors.lastname: Delaugerre
authors.affiliation: Paris Descartes University, EA 7327, Necker Medical School AP-HP, Unit of Therapeutics in Immunology and Infectiology, Hotel Dieu Hospital.
authors.forename: Jade
authors.initials: J
authors.lastname: Ghosn
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Lacombe
authors.affiliation: Infectious Diseases, UPMC-Tenon Hospital-AP-HP, Paris.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.affiliation: Infectious Diseases, CHU Toulouse.
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.affiliation: Paris Descartes University, AP-HP, Cochin Hospital, Paris.
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
authors.affiliation: Infectious Diseases, Conception Hospital-APHM, Marseille.
authors.forename: Amélie
authors.initials: A
authors.lastname: Menard
authors.affiliation: Infectious Diseases, Versailles St Quentin en Yvelines University, R Poincare Hospital-AP-HP, Garches, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: de Truchis
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: HIV; antiretroviral; calendar trend; virologic failure