Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: The U.S. Military HIV Natural History Study

Vincent C. Marconi, Greg A. Grandits, Amy C. Weintrob, Helen Chun, Michael L. Landrum, Anuradha Ganesan, Jason F. Okulicz, Nancy Crum-Cianflone, Robert J. O'Connell, Alan Lifson, Glenn W. Wortmann, Brian K. Agan

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64 Scopus citations

Abstract

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 cells/ml 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 ≥ 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.

Original languageEnglish (US)
Article number14
JournalAIDS Research and Therapy
Volume7
DOIs
StatePublished - May 27 2010

Bibliographical note

Funding Information:
The authors would like to thank our patients for their enormous contributions over the years and the IDCRP HIV Working Group: Susan Banks, Mary Bavaro, MD, Cathy Decker, MD, Anne Eaton, BA, Connor Eggleston, Patricia Grambsch, PhD, Cliff Hawkes, MD, Linda Jagodzinski, PhD, Arthur Johnson, MD, Jason Maguire, MD, Scott Merritt, Sheila Peel, PhD, Michael Polis, MD, John Powers, MD, Roseanne A. Ressner, MD, Ken Svendsen, MS, Edmund Tramont, MD, Sybil Tasker, MD, Mark R. Wallace, MD, Timothy Whitman, MD, Michael Zapor, MD. We would also like to thank David Bangsberg, MD for his critical review of this manuscript. Support for this work (IDCRP-000-03) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072. This support included study design, data collection, analysis, data interpretation, manuscript writing, and submission. The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. This work is original and has not been published elsewhere. Portions were presented at the 16th Conference on Retroviruses and Opportunistic Infections, Montreal, Canada (Abstract #582).

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