Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004-2015
AuthorMcManus, H; Callander, D; Donovan, B; Russell, DB; O'Connor, CC; Davies, SC; Lewis, DA; Hellard, ME; Chen, MY; Petoumenos, K; ...
Source TitleMedical Journal of Australia
AffiliationMelbourne School of Population and Global Health
Document TypeJournal Article
CitationsMcManus, H., Callander, D., Donovan, B., Russell, D. B., O'Connor, C. C., Davies, S. C., Lewis, D. A., Hellard, M. E., Chen, M. Y., Petoumenos, K., Varma, R., Cogle, A., Boyd, M. A., Grulich, A., Pollard, J., Medland, N., Fairley, C. K. & 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), pp.269-275. https://doi.org/10.5694/mja2.50006.
Access StatusOpen Access
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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