Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009

David B. Hanna; Kate Buchacz; Kelly A. Gebo; Nancy A. Hessol; Michael A. Horberg; Lisa P. Jacobson; Gregory D. Kirk; Mari M. Kitahata; P. Todd Korthuis; Richard D. Moore; Sonia Napravnik; Pragna Patel; Michael J. Silverberg; Timothy R. Sterling; James H. Willig; Bryan Lau; Keri N. Althoff; Heidi M. Crane; Ann C. Collier; Hasina Samji; Jennifer E. Thorne; M. John Gill; Marina B. Klein; Jeffrey N. Martin; Benigno Rodriguez; Sean B. Rourke; Stephen J. Gange

doi:10.1093/cid/cit003

Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009

David B. Hanna, Kate Buchacz, Kelly A. Gebo, Nancy A. Hessol, Michael A. Horberg, Lisa P. Jacobson, Gregory D. Kirk, Mari M. Kitahata, P. Todd Korthuis, Richard D. Moore, Sonia Napravnik, Pragna Patel, Michael J. Silverberg, Timothy R. Sterling, James H. Willig, Bryan Lau, Keri N. Althoff, Heidi M. Crane, Ann C. Collier, Hasina SamjiJennifer E. Thorne, M. John Gill, Marina B. Klein, Jeffrey N. Martin, Benigno Rodriguez, Sean B. Rourke, Stephen J. Gange

Internal Medicine

Research output: Contribution to journal › Article › peer-review

85 Scopus citations

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 (P_trend <. 001). The cumulative incidence of 1-year virologic suppression increased from 55% to 81%, and among ART initiators, from 84% to 93% (both P_trend <. 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.

Original language	English (US)
Pages (from-to)	1174-1182
Number of pages	9
Journal	Clinical Infectious Diseases
Volume	56
Issue number	8
DOIs	https://doi.org/10.1093/cid/cit003
State	Published - Apr 15 2013

Keywords

HIV
antiretroviral therapy
healthcare disparities
time factors
viral load

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

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10.1093/cid/cit003

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Hanna, D. B., Buchacz, K., Gebo, K. A., Hessol, N. A., Horberg, M. A., Jacobson, L. P., Kirk, G. D., Kitahata, M. M., Korthuis, P. T., Moore, R. D., Napravnik, S., Patel, P., Silverberg, M. J., Sterling, T. R., Willig, J. H., Lau, B., Althoff, K. N., Crane, H. M., Collier, A. C., ... Gange, S. J. (2013). Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009. Clinical Infectious Diseases, 56(8), 1174-1182. https://doi.org/10.1093/cid/cit003

Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009. / Hanna, David B.; Buchacz, Kate; Gebo, Kelly A. et al.

In: Clinical Infectious Diseases, Vol. 56, No. 8, 15.04.2013, p. 1174-1182.

Research output: Contribution to journal › Article › peer-review

Hanna, DB, Buchacz, K, Gebo, KA, Hessol, NA, Horberg, MA, Jacobson, LP, Kirk, GD, Kitahata, MM, Korthuis, PT, Moore, RD, Napravnik, S, Patel, P, Silverberg, MJ, Sterling, TR, Willig, JH, Lau, B, Althoff, KN, Crane, HM, Collier, AC, Samji, H, Thorne, JE, Gill, MJ, Klein, MB, Martin, JN, Rodriguez, B, Rourke, SB & Gange, SJ 2013, 'Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009', Clinical Infectious Diseases, vol. 56, no. 8, pp. 1174-1182. https://doi.org/10.1093/cid/cit003

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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: 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",

}

TY - JOUR

T1 - Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009

AU - Hanna, David B.

AU - Buchacz, Kate

AU - Gebo, Kelly A.

AU - Hessol, Nancy A.

AU - Horberg, Michael A.

AU - Jacobson, Lisa P.

AU - Kirk, Gregory D.

AU - Kitahata, Mari M.

AU - Korthuis, P. Todd

AU - Moore, Richard D.

AU - Napravnik, Sonia

AU - Patel, Pragna

AU - Silverberg, Michael J.

AU - Sterling, Timothy R.

AU - Willig, James H.

AU - Lau, Bryan

AU - Althoff, Keri N.

AU - Crane, Heidi M.

AU - Collier, Ann C.

AU - Samji, Hasina

AU - Thorne, Jennifer E.

AU - Gill, M. John

AU - Klein, Marina B.

AU - Martin, Jeffrey N.

AU - Rodriguez, Benigno

AU - Rourke, Sean B.

AU - Gange, Stephen J.

N1 - 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.

PY - 2013/4/15

Y1 - 2013/4/15

N2 - 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.

AB - 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.

KW - HIV

KW - antiretroviral therapy

KW - healthcare disparities

KW - time factors

KW - viral load

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U2 - 10.1093/cid/cit003

DO - 10.1093/cid/cit003

M3 - Article

C2 - 23315317

AN - SCOPUS:84875654819

VL - 56

SP - 1174

EP - 1182

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 8

ER -

Trends and disparities in antiretroviral therapy initiation and Virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009

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