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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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.
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.
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.
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.
KeywordsHIV Antiretroviral therapy START Treatment guidelines Adherence
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.
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.
Compliance with ethical standards
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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