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Benefits of HIV treatment observed across all risk groups
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Advances in HIV treatment have positively affected those with HIV in all demographic and behavioral risk groups, according to recent data, which also indicate that the longevity for those with HIV is now 73 years.
“Contemporary HIV medications can be highly effective in all HIV-infected individuals, regardless of their demographic background and how they became infected,” Richard D. Moore, MD, MHS, professor of medicine at Johns Hopkins University, told Infectious Disease News. “They are likely to be most effective when received by patients in a setting where potential barriers in access to care are identified and managed comprehensively.”
Richard D. Moore
Moore and colleagues used data from a clinical HIV cohort in Baltimore. They analyzed data obtained from 1995 to 2010 regarding the use of ART, HIV-1 RNA, CD4 counts, incidence of opportunistic illness and mortality. They then compared these findings by risk group, sex and race.
The study included 6,366 patients that resulted in 27,941 person-years of follow-up. Among all risk groups, the rate of patients receiving ART increased over time, with 87% of all patients receiving therapy by 2010. There were no differences in ART therapy by group, sex or race.
Median HIV-1 RNA level declined during the study period, with the median level being <200 copies/mL among all groups in 2010. Among injection drug users, the median HIV-1 RNA level was 0.16 log10 copies/mL higher compared with other groups. The median CD4 count increased over time in all groups, with the median CD4 count being 475 cells/mm3 in 2010. Injection drug users had a median CD4 count that was 79 cells/mm3 lower than other risk groups.
The incidence of opportunistic illness declined significantly over time, to a rate of 2.4 per 100 person-years by 2010. Mortality rates also declined. The greatest decline in mortality was from 1995 to 1998, although smaller declines were seen after. By 2010, the mortality rate was 2.1 per 100 person-years. There was no significant difference in opportunistic illness or mortality by risk group, race or sex.
“These results may not reflect the care received by HIV-infected individuals across the United States, and particularly in injection drug users, further improvement is needed,” the researchers wrote. “Nevertheless, we believe that our results reflect an effective model of care, and should continue in the United States if individuals with HIV infection are to have the maximal benefit possible from modern HIV care.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
The advances in the outcome of HIV infection with the widespread use of effective antiretroviral therapy remain impressive. One concern has focused on the degree to which some sub-populations may not be included in this improvement due to limited healthcare access or other social and economic issues. This paper provides clear evidence that in at least one large and diverse urban population, the benefits of HIV treatment are reaching across the divisions of mode of infection, race, and economic status. These data should encourage similar research in other geographic areas, particularly rural ones where stigma and geographic distances to expert care may remain barriers to care. The challenge is now to make sure that the results in Baltimore are realized across the country and that we redouble efforts to replicate this worldwide
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