Dataset Information

Trends in Follow-Up Visits Among People Living With HIV: Results From the TREAT Asia and Australian HIV Observational Databases.

ABSTRACT:

Background

Less frequent follow-up visits may reduce the burden on people living with HIV (PLHIV) and health care facilities. We aimed to assess trends in follow-up visits and survival outcomes among PLHIV in Asia and Australasia.

Settings

PLHIV enrolled in TREAT Asia HIV Observational Database (TAHOD) or Australian HIV Observational Database (AHOD) from 2008 to 2017 were included.

Methods

Follow-up visits included laboratory testing and clinic visit dates. Visit rates and survival were analyzed using repeated measure Poisson regression and competing risk regression, respectively. Additional analyses were limited to stable PLHIV with viral load <1000 copies/mL and self-reported adherence ≥95%.

Results

We included 7707 PLHIV from TAHOD and 3289 PLHIV from AHOD. Visit rates were 4.33 per person-years (/PYS) in TAHOD and 3.68/PYS in AHOD. Both TAHOD and AHOD showed decreasing visit rates in later calendar years compared with that in years 2008-2009 (P < 0.001 for both cohorts). Compared with PLHIV with 2 visits, those with ≥4 visits had poorer survival: TAHOD ≥4 visits, subhazard ratio (SHR) = 1.88, 95% confidence interval (CI): 1.16 to 3.03, P = 0.010; AHOD ≥4 visits, SHR = 1.80, 95% CI: 1.10 to 2.97, P = 0.020; whereas those with ≤1 visit showed no differences in mortality. The association remained evident among stable PLHIV: TAHOD ≥4 visits, SHR = 5.79, 95% CI: 1.84 to 18.24, P = 0.003; AHOD ≥4 visits, SHR = 2.15, 95% CI: 1.20 to 3.85, P = 0.010, compared with 2 visits.

Conclusions

Both TAHOD and AHOD visit rates have declined. Less frequent visits did not affect survival outcomes; however, poorer health possibly leads to increased follow-up and higher mortality. Reducing visit frequency may be achievable among PLHIV with no other medical complications.

SUBMITTER: Jiamsakul A

PROVIDER: S-EPMC8373656 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Publications

Trends in Follow-Up Visits Among People Living With HIV: Results From the TREAT Asia and Australian HIV Observational Databases.

Jiamsakul Awachana A Boyd Mark M Choi Jun Yong JY Edmiston Natalie N Kumarasamy Nagalingeswaran N Hutchinson Jolie J Law Matthew M Ditangco Rossana R

Journal of acquired immune deficiency syndromes (1999) 20210901 1

<h4>Background</h4>Less frequent follow-up visits may reduce the burden on people living with HIV (PLHIV) and health care facilities. We aimed to assess trends in follow-up visits and survival outcomes among PLHIV in Asia and Australasia.<h4>Settings</h4>PLHIV enrolled in TREAT Asia HIV Observational Database (TAHOD) or Australian HIV Observational Database (AHOD) from 2008 to 2017 were included.<h4>Methods</h4>Follow-up visits included laboratory testing and clinic visit dates. Visit rates and ...[more]

PMID: 33990493

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Project description:BackgroundAntiretroviral therapy (ART) has evolved rapidly since its beginnings. This analysis describes trends in first-line ART use in Asia and their impact on treatment outcomes.MethodsPatients in the TREAT Asia HIV Observational Database receiving first-line ART for ≥ 6 months were included. Predictors of treatment failure and treatment modification were assessed.ResultsData from 4662 eligible patients was analysed. Patients started ART in 2003-2006 (n = 1419), 2007-2010 (n = 2690) and 2011-2013 (n = 553). During the observation period, tenofovir, zidovudine and abacavir use largely replaced stavudine. Stavudine was prescribed to 5.8% of ART starters in 2012/13. Efavirenz use increased at the expense of nevirapine, although both continue to be used extensively (47.5% and 34.5% of patients in 2012/13, respectively). Protease inhibitor use dropped after 2004. The rate of treatment failure or modification declined over time (22.1 [95%CI 20.7-23.5] events per 100 patient/years in 2003-2006, 15.8 [14.9-16.8] in 2007-2010, and 11.6 [9.4-14.2] in 2011-2013). Adjustment for ART regimen had little impact on the temporal decline in treatment failure rates but substantially attenuated the temporal decline in rates of modification due to adverse event. In the final multivariate model, treatment modification due to adverse event was significantly predicted by earlier period of ART initiation (hazard ratio 0.52 [95%CI 0.33-0.81], p = 0.004 for 2011-2013 versus 2003-2006), older age (1.56 [1.19-2.04], p = 0.001 for ≥ 50 years versus <30 years), female sex (1.29 [1.11-1.50], p = 0.001 versus male), positive hepatitis C status (1.33 [1.06-1.66], p = 0.013 versus negative), and ART regimen (11.36 [6.28-20.54], p<0.001 for stavudine-based regimens versus tenofovir-based).ConclusionsThe observed trends in first-line ART use in Asia reflect changes in drug availability, global treatment recommendations and prescriber preferences over the past decade. These changes have contributed to a declining rate of treatment modification due to adverse event, but not to reductions in treatment failure.

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Project description:BackgroundHematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia.MethodsIncidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan-Meier.ResultsOf 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351-500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy.ConclusionsNonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.

Dataset Information

Trends in Follow-Up Visits Among People Living With HIV: Results From the TREAT Asia and Australian HIV Observational Databases.

Background

Settings

Methods

Results

Conclusions

Publications

Trends in Follow-Up Visits Among People Living With HIV: Results From the TREAT Asia and Australian HIV Observational Databases.

Similar Datasets

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