Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare the U.S. Military HIV Natural History Study 英文参考文献.docVIP

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Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare the U.S. Military HIV Natural History Study 英文参考文献.doc

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Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare the U.S. Military HIV Natural History Study 英文参考文献

Marconi et al. AIDS Research and Therapy 2010, 7:14 /content/7/1/14 RESEARCH Open Access Outcomes of highly active antiretroviral therapy in Research the context of universal access to healthcare: the U.S. Military HIV Natural History Study Vincent C Marconi*1,2,8, Greg A Grandits1,3, Amy C Weintrob1,4, Helen Chun1,5, Michael L Landrum1,2, Anuradha Ganesan1,6, Jason F Okulicz1,2, Nancy Crum-Cianflone1,4, Robert J OConnell1,7, Alan Lifson1,3, Glenn W Wortmann1,4, Brian K Agan*1 and the Infectious Disease Clinical Research Program HIV Working Group (IDCRP) 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