Outcomes of Highly Active Antiretroviral Therapy in the Context of Universal Access to Healthcare: The U.S. Military HIV Natural History Study
UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
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Background To examine the outcomes of highly-active antiretroviral therapy HAART for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007. Methods Outcomes analyzed were virologic suppression VS and failure VF, CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate MV analyses stratified by the HAART initiation year before or after 2000 were performed to identify risk factors associated with these outcomes. Results Among patients who started HAART after 2000, 81 had VS at 1 year N 1,759, 85 at 5 years N 1,061 and 82 at 8 years N 735. Five years post-HAART, the median CD4 increase was 247 cellsml and 34 experienced VF. AIDS and mortality rates at 5 years were 2 and 0.3, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty versus retired at HAART initiation was associated with a decreased risk of AIDS HR 0.6, 95 CI 0.4-1.0 and mortality 0.6, 0.3-0.9, an increased probability of CD4 increase more than 50 1.2, 1.0-1.4, but was not significant for VF. Conclusions In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.
- Medicine and Medical Research