title: Temporal trends of time to antiretroviral treatment initiation, interruption and modification: examination of patients diagnosed with advanced HIV in Australia.
abstract: BACKGROUND
  HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART.
  
  
  METHODS
  We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification.
  
  
  RESULTS
  Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV.
  
  
  CONCLUSIONS
  Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.
authors: The Kirby Institute, UNSW Australia, Sydney, Australia; swright@kirby.unsw.edu.au.
authors: Stephen T
authors: ST
authors: Wright
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Matthew G
authors: MG
authors: Law
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: David A
authors: DA
authors: Cooper
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Phillip
authors: P
authors: Keen
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Ann
authors: A
authors: McDonald
authors: Health Protection, Communicable Diseases Branch, NSW Government Health, Sydney, Australia.
authors: Melanie
authors: M
authors: Middleton
authors: Department of Medicine, Monash University, Melbourne, Australia.|Department of Infectious Diseases, Monash University, Melbourne, Australia.|Infectious Diseases, Monash Medical Centre, Melbourne, Australia.
authors: Ian
authors: I
authors: Woolley
authors: Brisbane Sexual Health and HIV Services, Brisbane, Australia.
authors: Mark
authors: M
authors: Kelly
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Kathy
authors: K
authors: Petoumenos
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001315:Australia; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: advanced HIV diagnosis; combination antiretroviral therapy; late diagnosis; treatment interruption; treatment modification