title: Virologic suppression among HIV-infected US Air Force members in a highly-structured programme with free access to care.
abstract: SummaryThe United States Air Force HIV programme has several features that may enhance antiretroviral therapy outcomes, including free access to healthcare and mandatory clinical visits every six months at a single centre. We evaluated viral load suppression (<50 copies/ml) after 12 months of initial antiretroviral therapy, with extension to 18 and 24 months. Active duty Air Force members were categorised by year of antiretroviral therapy initiation: 2000-2005 (n = 95, 36.1%) and 2006-2011 (n = 168, 63.9%). The median months from HIV diagnosis to initial antiretroviral therapy were shorter in the 2000-2005 group (2.4, IQR 1.2-5.9) compared with the 2006-2011 group (12.6, IQR 2.6-29.0; p < 0.001). Viral load suppression was greater in the 2006-2011 group compared with the 2000-2005 group at 12 months (93.2% versus 78.6%, p = 0.002) and 18 months (91.8% versus 80.3%, p = 0.03), and trended higher at 24 months (90.8% versus 82.5%; p = 0.15). Factors associated with viral load suppression at 12 months in multivariate models included antiretroviral therapy initiation during 2006-2011 (OR 5.22, 95% CI 1.50-18.18) and CD4 count at antiretroviral therapy initiation (OR 2.29, 95% CI 1.19-14.43 per 100 cells/µl increase). Structured programmes that minimise traditional barriers to care combined with the use of contemporary antiretroviral therapy regimens can achieve clinic-wide viral load suppression in >90% of patients.
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Matthews
authors.affiliation: The Veterans Affairs Research Center for AIDS and HIV-1 Infection and Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: T
authors.initials: T
authors.lastname: Le
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Delmar
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA jason.f.okulicz.mil@mail.mil.
authors.forename: J F
authors.initials: JF
authors.lastname: Okulicz
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006297:Health Services Accessibility; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008889:Military Personnel; D015397:Program Evaluation; D012367:RNA, Viral; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: AIDS; Air Force; HAART; HIV; antiretroviral therapy; continuum of care; military; treatment; treatment cascade