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Antiretroviral treatment indications and adherence to the German-Austrian treatment initiation guidelines in the German ClinSurv HIV Cohort between 1999 and 2016

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A Correction to this article was published on 25 February 2019

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Abstract

Purpose

The aim of the study was to assess guideline adherence to combined antiretroviral therapy (ART) in the German ClinSurv HIV Cohort and the real-life impact of the Strategic Timing of Antiretroviral Therapy (START) study, to identify patients not treated as recommended by new guidelines.

Methods

We used data from the multicenter ClinSurv cohort of the Robert-Koch-Institute (RKI) between 1999 and 2016. Inclusion criteria were people living with HIV/AIDS, ≥ 18 years of age and cART naïve at the first visit (FV). Adherence was defined as starting cART within 6 months of crossing the CD4+ T cell threshold as suggested by the German-Austrian treatment guidelines. Logistic regression was used to identify factors associated with non-adherence.

Results

11,817 patients met the inclusion criteria. We observed an overall adherence rate of 60%, in patients with treatment indication who started cART timely between 2002 and 2015. Adherence rate increased constantly, demonstrating a potential increase in patients, with treatment indication, starting cART within 6 months of presentation from 55% in 2008 to 94% in 2015. Patients reporting injection drug use (OR 2.18, 95% CI 1.70–2.95) and patients between 18 years and 39 years of age at the time of their first visit (OR 2.89, 95% CI 1.35–6.18) were identified as risk groups associated with non-adherence.

Conclusion

The majority of patients below the CD4+ T cell count threshold of applicable guidelines initiated treatment within 6 months. We observed a slowly diminishing proportion of patients not starting cART timely. Delayed treatment was more frequent in patients reporting injection drug use.

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Change history

  • 25 February 2019

    In this article the cooperating partners of the ClinSurv HIV cohort were not listed in the acknowledgements. The correct paragraph appears below.

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Acknowledgements

This study was funded by the German Center for Infection Research. Initial results of this study were presented at the ‘21st International Workshop on HIV and Hepatitis Observational Databases’ in Lisbon, Portugal 2016, Abstract no: 109.

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Authors and Affiliations

  1. Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany

    Melanie Stecher, Philipp Schommers, Clara Lehmann, Martin Platten, Gerd Fätkenheuer & Jörg Janne Vehreschild

  2. Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany

    Melanie Stecher, Philipp Schommers, Clara Lehmann, Gerd Fätkenheuer & Jörg Janne Vehreschild

  3. Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

    Daniel Schmidt, Christian Kollan & Barbara Gunsenheimer-Bartmeyer

  4. Charité – University Medicine Berlin, Berlin, Germany

    Daniel Schmidt

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  1. Melanie Stecher
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ClinSurv Study Group

Contributions

JV and MS designed the study, analyzed and interpreted the data. MS drafted the primary draft of the manuscript. BG, CK and DS provided data, and contributed critically important ideas on how to interpret the data. PS, BG, CK, DS, MP, CL and GF revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript.

Corresponding authors

Correspondence to Melanie Stecher or Jörg Janne Vehreschild.

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Conflict of interest

This study is a project within the TP-HIV by the German Centre for Infection Research (DZIF) (NCT02149004). We declare that all authors have no conflicts of interest.

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Stecher, M., Schommers, P., Schmidt, D. et al. Antiretroviral treatment indications and adherence to the German-Austrian treatment initiation guidelines in the German ClinSurv HIV Cohort between 1999 and 2016. Infection 47, 247–255 (2019). https://doi.org/10.1007/s15010-018-1248-8

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