Outcomes in the first year after initiation of first-line HAART among heterosexual men and women in the UK CHIC Study

Barber, Tristan J, Geretti, Anna Maria, Anderson, Jane, Schwenk, Achim, Phillips, Andrew N, Bansi, Loveleen, Gilson, Richard, Hill, Teresa, Walsh, John, Fisher, Martin, Johnson, Margaret, Post, Frank, Easterbrook, Philippa, Gazzard, Brian, Palfreeman, Adrian, Orkin, Chloe, Leen, Clifford, Gompels, Mark, Dunn, David, Delpech, Valerie, Pillay, Deenan, Sabin, Caroline A, The UK CHIC Study Steering Committee, and Fisher, Martin (2011) Outcomes in the first year after initiation of first-line HAART among heterosexual men and women in the UK CHIC Study. Antiviral Therapy, 16 (6). pp. 805-814. ISSN 2040-2058

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Abstract

BACKGROUND

We analysed the influence of gender on use and outcomes of first-line HAART in a UK cohort.

METHODS

Analyses included heterosexuals starting HAART from 1998-2007 with pre-treatment CD4(+) T-cell count<350 cells/mm(3) and viral load (VL)>500 copies/ml. Virological suppression (<50 copies/ml), virological rebound (>500 copies/ml), CD4(+) T-cell counts at 6 and 12 months, clinical events and treatment discontinuation/switch in the first year of HAART were compared using linear, logistic and Cox regression.

RESULTS

Compared with women (n=2,179), men (n=1,487) were older and had lower CD4(+) T-cell count and higher VL at start of HAART. Median follow-up was 3.8 years (IQR 2.0-6.2). At 6 and 12 months, 72.7% and 75.3% had VL≤50 copies/ml, with no large differences between genders at either time after adjustment for confounders (6 months, OR 0.92 [95% CI 0.76-1.13]; 12 months, OR 1.06 [95% CI 0.85-1.31]). Overall, 79.4% patients achieved virological suppression and 19.2% experienced virological rebound, without gender differences, although men had an increased risk of rebound after excluding pregnant women (adjusted relative hazard [RH] 1.33 [95% CI 1.04-1.71]). Mean CD4(+) T-cell count increases at 6 and 12 months were, respectively, 112 and 156 cells/mm(3) overall, with mean differences between men and women of -14.6 cells/mm(3) (95% CI -24.6--4.5) and -12.1 cells/mm(3) (95% CI -24.4-0.2) at 6 and 12 months, respectively. Clinical progression was similar in men and women, but men were less likely to experience treatment discontinuation/switch (adjusted RH 0.72 [95% CI 0.63-0.83]).

CONCLUSIONS

Despite higher discontinuation rates among women, men had an increased risk of virological rebound and slightly poorer CD4(+) T-cell count responses. Identifying the reasons underlying treatment discontinuation/switch may help optimize treatment strategies for both genders.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
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Depositing User: Ellen Thomas
Date Deposited: 14 Jan 2014 09:52
Last Modified: 14 Jan 2014 09:52
URI: http://sro.sussex.ac.uk/id/eprint/47286
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