Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia

trends and predictors, 2004–2015

Hamish McManus, Denton Callander, Basil Donovan, Darren B. Russell, Catherine C. O'Connor, Stephen C. Davies, David A. Lewis, Margaret E Hellard, Marcus Y Chen, Kathy Petoumenos, Rick Varma, Aaron Cogle, Mark Alastair Boyd, Andrew Grulich, James Pollard, Nick Medland, Christopher K Fairley, Rebecca J. Guy

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

Objectives: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. Design, setting: Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. Participants: Patients diagnosed with HIV infections, January 2004 – June 2015. Main outcome measures: Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4 + cell count at diagnosis. Results: 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27–43 years), and 841 (92%) were men; the median CD4 + cell count at diagnosis was 510 cells/μL (IQR, 350–674 cells/μL). The proportion of patients who received early treatment increased from 17% (15 patients) in 2004–06 to 20% (34 patients) in 2007–09, 34% (95 patients) in 2010–12, and 53% (197 patients) in 2013–15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4 + cell counts and higher viral loads at diagnosis. Conclusions: The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004–2015, reflecting changes in the CD4 + cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.

Original languageEnglish
Pages (from-to)269-275
Number of pages7
JournalMedical Journal of Australia
Volume210
Issue number6
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • Epidemiologic measurements
  • Immunotherapies
  • Prevention and control

Cite this

McManus, H., Callander, D., Donovan, B., Russell, D. B., O'Connor, C. C., Davies, S. C., ... Guy, R. J. (2019). Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015. Medical Journal of Australia, 210(6), 269-275. https://doi.org/10.5694/mja2.50006
McManus, Hamish ; Callander, Denton ; Donovan, Basil ; Russell, Darren B. ; O'Connor, Catherine C. ; Davies, Stephen C. ; Lewis, David A. ; Hellard, Margaret E ; Chen, Marcus Y ; Petoumenos, Kathy ; Varma, Rick ; Cogle, Aaron ; Boyd, Mark Alastair ; Grulich, Andrew ; Pollard, James ; Medland, Nick ; Fairley, Christopher K ; Guy, Rebecca J. / Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia : trends and predictors, 2004–2015. In: Medical Journal of Australia. 2019 ; Vol. 210, No. 6. pp. 269-275.
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title = "Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015",
abstract = "Objectives: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. Design, setting: Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. Participants: Patients diagnosed with HIV infections, January 2004 – June 2015. Main outcome measures: Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4 + cell count at diagnosis. Results: 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27–43 years), and 841 (92{\%}) were men; the median CD4 + cell count at diagnosis was 510 cells/μL (IQR, 350–674 cells/μL). The proportion of patients who received early treatment increased from 17{\%} (15 patients) in 2004–06 to 20{\%} (34 patients) in 2007–09, 34{\%} (95 patients) in 2010–12, and 53{\%} (197 patients) in 2013–15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4 + cell counts and higher viral loads at diagnosis. Conclusions: The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17{\%} to 53{\%} during 2004–2015, reflecting changes in the CD4 + cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.",
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author = "Hamish McManus and Denton Callander and Basil Donovan and Russell, {Darren B.} and O'Connor, {Catherine C.} and Davies, {Stephen C.} and Lewis, {David A.} and Hellard, {Margaret E} and Chen, {Marcus Y} and Kathy Petoumenos and Rick Varma and Aaron Cogle and Boyd, {Mark Alastair} and Andrew Grulich and James Pollard and Nick Medland and Fairley, {Christopher K} and Guy, {Rebecca J.}",
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McManus, H, Callander, D, Donovan, B, Russell, DB, O'Connor, CC, Davies, SC, Lewis, DA, Hellard, ME, Chen, MY, Petoumenos, K, Varma, R, Cogle, A, Boyd, MA, Grulich, A, Pollard, J, Medland, N, Fairley, CK & Guy, RJ 2019, 'Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015', Medical Journal of Australia, vol. 210, no. 6, pp. 269-275. https://doi.org/10.5694/mja2.50006

Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia : trends and predictors, 2004–2015. / McManus, Hamish; Callander, Denton; Donovan, Basil; Russell, Darren B.; O'Connor, Catherine C.; Davies, Stephen C.; Lewis, David A.; Hellard, Margaret E; Chen, Marcus Y; Petoumenos, Kathy; Varma, Rick; Cogle, Aaron; Boyd, Mark Alastair; Grulich, Andrew; Pollard, James; Medland, Nick; Fairley, Christopher K; Guy, Rebecca J.

In: Medical Journal of Australia, Vol. 210, No. 6, 01.04.2019, p. 269-275.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia

T2 - trends and predictors, 2004–2015

AU - McManus, Hamish

AU - Callander, Denton

AU - Donovan, Basil

AU - Russell, Darren B.

AU - O'Connor, Catherine C.

AU - Davies, Stephen C.

AU - Lewis, David A.

AU - Hellard, Margaret E

AU - Chen, Marcus Y

AU - Petoumenos, Kathy

AU - Varma, Rick

AU - Cogle, Aaron

AU - Boyd, Mark Alastair

AU - Grulich, Andrew

AU - Pollard, James

AU - Medland, Nick

AU - Fairley, Christopher K

AU - Guy, Rebecca J.

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N2 - Objectives: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. Design, setting: Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. Participants: Patients diagnosed with HIV infections, January 2004 – June 2015. Main outcome measures: Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4 + cell count at diagnosis. Results: 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27–43 years), and 841 (92%) were men; the median CD4 + cell count at diagnosis was 510 cells/μL (IQR, 350–674 cells/μL). The proportion of patients who received early treatment increased from 17% (15 patients) in 2004–06 to 20% (34 patients) in 2007–09, 34% (95 patients) in 2010–12, and 53% (197 patients) in 2013–15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4 + cell counts and higher viral loads at diagnosis. Conclusions: The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004–2015, reflecting changes in the CD4 + cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.

AB - Objectives: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. Design, setting: Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. Participants: Patients diagnosed with HIV infections, January 2004 – June 2015. Main outcome measures: Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4 + cell count at diagnosis. Results: 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27–43 years), and 841 (92%) were men; the median CD4 + cell count at diagnosis was 510 cells/μL (IQR, 350–674 cells/μL). The proportion of patients who received early treatment increased from 17% (15 patients) in 2004–06 to 20% (34 patients) in 2007–09, 34% (95 patients) in 2010–12, and 53% (197 patients) in 2013–15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4 + cell counts and higher viral loads at diagnosis. Conclusions: The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004–2015, reflecting changes in the CD4 + cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.

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