@article{fad920ba845248b5a05cd95b0d6830df,
title = "Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009",
abstract = "Background. Since the mid-1990s, effective antiretroviral therapy (ART) regimens have improved in potency, tolerability, ease of use, and class diversity. We sought to examine trends in treatment initiation and resulting human immunodeficiency virus (HIV) virologic suppression in North America between 2001 and 2009, and demographic and geographic disparities in these outcomes.Methods. We analyzed data on HIV-infected individuals newly clinically eligible for ART (ie, first reported CD4+ count <350 cells/L or AIDS-defining illness, based on treatment guidelines during the study period) from 17 North American AIDS Cohort Collaboration on Research and Design cohorts. Outcomes included timely ART initiation (within 6 months of eligibility) and virologic suppression (≤500 copies/mL, within 1 year). We examined time trends and considered differences by geographic location, age, sex, transmission risk, race/ethnicity, CD4+ count, and viral load, and documented psychosocial barriers to ART initiation, including non-injection drug abuse, alcohol abuse, and mental illness.Results. Among 10 692 HIV-infected individuals, the cumulative incidence of 6-month ART initiation increased from 51% in 2001 to 72% in 2009 (Ptrend <. 001). The cumulative incidence of 1-year virologic suppression increased from 55% to 81%, and among ART initiators, from 84% to 93% (both Ptrend <. 001). A greater number of psychosocial barriers were associated with decreased ART initiation, but not virologic suppression once ART was initiated. We found significant heterogeneity by state or province of residence (P <. 001).Conclusions. In the last decade, timely ART initiation and virologic suppression have greatly improved in North America concurrent with the development of better-tolerated and more potent regimens, but significant barriers to treatment uptake remain, both at the individual level and systemwide.",
keywords = "HIV, antiretroviral therapy, healthcare disparities, time factors, viral load",
author = "Hanna, {David B.} and Kate Buchacz and Gebo, {Kelly A.} and Hessol, {Nancy A.} and Horberg, {Michael A.} and Jacobson, {Lisa P.} and Kirk, {Gregory D.} and Kitahata, {Mari M.} and Korthuis, {P. Todd} and Moore, {Richard D.} and Sonia Napravnik and Pragna Patel and Silverberg, {Michael J.} and Sterling, {Timothy R.} and Willig, {James H.} and Bryan Lau and Althoff, {Keri N.} and Crane, {Heidi M.} and Collier, {Ann C.} and Hasina Samji and Thorne, {Jennifer E.} and Gill, {M. John} and Klein, {Marina B.} and Martin, {Jeffrey N.} and Benigno Rodriguez and Rourke, {Sean B.} and Gange, {Stephen J.}",
note = "Funding Information: Potential conflicts of interest. K. A. G. has served as a consultant to Tibotec and Bristol-Myers Squibb (BMS) and has received research funding from Tibotec. M. A. H. has received research funding from Merck and Pfizer. L. P. J. has served as a consultant to BMS. G. D. K. has served as a consultant to GlaxoSmithKline (GSK) and Merck, and has received payment for educational presentations from GSK. R. D. M. has served as a consultant to Gilead. M. J. S. has received research funding from Merck and Pfizer. T. R. S. has received research funding from Pfizer and BMS and has served on an advisory board for Otsuka. J. H. W. has served as a consultant to BMS, Definicare, and Gilead, and has received research funding from BMS, Definicare, Gilead, Pfizer, and Tibotec. H. M. C. has received payment for educational presentations from Medscape. A. C. C. has received research funding from Schering-Plough and Merck, has served on an advisory board for Merck, and has past stock options from Abbott, BMS, Johnson & Johnson, and Pfizer. J. E. T. has served on an advisory board for Allergan and has served as a consultant to Santen and XOMA. M. J. G. has served on advisory boards for Abbott, ViiV, Gilead, Janssen, and Merck. M. B. K. has served as a consultant to ViiV, has received research funding from Merck, and has received payment for lectures or educational presentations from BMS, Gilead, and ViiV. B. R. has served as a consultant to Gilead. S. B. R. has served as a consultant to and has received payment for lectures and educational presentations from Abbott. S. J. G. has served on an advisory board for Merck. Funding Information: Financial support. This work was supported by the National Institutes of Health (grant numbers F31-DA30254, U01-AI069918, U01-AI31834, U01-AI34989, U01-AI34993, U01-AI34994, U01-AI35004, U01-AI35039, U01-AI35040, U01-AI35041, U01-AI35042, U01-AI35043, U01-AI37613, U01-AI37984, U01-AI42590, U01-HD32632, UL1-RR024131, UL1-RR024131, M01-RR-00052, M01-RR00071, M01-RR00079, M01-RR00083, M01-RR00722, M01-RR025747, P30-AI27757, P30-AI27767, P30-AI27763, P30-AI50410, P30-AI54999, P30-AI036219, R01-DA04334, R01-DA12568, R01-DA11602, R01-AA16893, R24-AI067039, AHQ290-01-0012, N02-CP55504, K01-AI071725, K01-AI071754, K01-AI093197, K23-AI610320, K24-DA00432, and K24-AI1065298); the Centers for Disease Control and Prevention (contract CDC200-2006-18797); the Canadian Institutes of Health Research (grant numbers TGF-96118, HCP-97105, CBR-86906, CBR-94036, KRS-86251, and 169621); the Canadian HIV Trials Network (project 24); and the government of British Columbia.",
year = "2013",
month = apr,
day = "15",
doi = "10.1093/cid/cit003",
language = "English (US)",
volume = "56",
pages = "1174--1182",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "8",
}