title: Growing challenges for HIV programmes in Asia: clinic population trends, 2003-2013.
abstract: The scale-up of antiretroviral therapy (ART) has led to a substantial change in the clinical population of HIV-positive patients receiving care. We describe the temporal trends in the demographic and clinical characteristics of HIV-positive patients initiating ART in 2003-13 within an Asian regional cohort. All HIV-positive adult patients that initiated ART between 2003 and 2013 were included. We summarized ART regimen use, age, CD4 cell count, HIV viral load, and HIV-related laboratory monitoring rates during follow-up by calendar year. A total of 16 962 patients were included in the analysis. Patients in active follow-up increased from 695 patients at four sites in 2003 to 11,137 patients at eight sites in 2013. The proportion of patients receiving their second or third ART regimen increased over time (5% in 2003 to 29% in 2013) along with patients aged ≥50 years (8% in 2003 to 18% in 2013). Concurrently, CD4 monitoring has remained stable in recent years, whereas HIV viral load monitoring, although varied among the sites, is increasing. There have been substantial changes in the clinical and demographic characteristics of HIV-positive patients receiving ART in Asia. HIV programmes will need to anticipate the clinical care needs for their aging populations, expanded viral load monitoring, and, the eventual increase in second and third ART regimens that will lead to higher costs and more complex drug procurement needs.
authors.affiliation: a The Kirby Institute , UNSW Australia , Sydney , Australia.
authors.forename: Nicole L
authors.identifier: 0000-0001-7739-3656
authors.initials: NL
authors.lastname: De La Mata
authors.affiliation: b YRGCARE Medical Centre , VHS , Chennai , India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: c National Center for HIV/AIDS , Dermatology & STDs , Phnom Penh , Cambodia.
authors.forename: Penh Sun
authors.initials: PS
authors.lastname: Ly
authors.affiliation: d Tan Tock Seng Hospital , Singapore.
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.affiliation: e National Hospital for Tropical Diseases , Hanoi , Vietnam.
authors.forename: Kinh Van
authors.initials: KV
authors.lastname: Nguyen
authors.affiliation: f Faculty of Medicine , Udayana University & Sanglah Hospital , Bali , Indonesia.
authors.forename: Tuti Parwati
authors.initials: TP
authors.lastname: Merati
authors.affiliation: g Queen Elizabeth Hospital , Hong Kong SAR , China.
authors.forename: Man Po
authors.initials: MP
authors.lastname: Lee
authors.affiliation: h Bach Mai Hospital , Hanoi , Vietnam.
authors.forename: Cuong Duy
authors.initials: CD
authors.lastname: Do
authors.affiliation: i Department of Internal Medicine and AIDS Research Institute , Yonsei University College of Medicine, Severance Hospital , Seoul , South Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.affiliation: j TREAT Asia, amfAR - The Foundation for AIDS Research , Bangkok , Thailand.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Ross
authors.affiliation: a The Kirby Institute , UNSW Australia , Sydney , Australia.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods*; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: ART; Asia; HIV; characteristics; clinical; demographics