Trends over calendar time in antiretroviral treatment success and failure in HIV clinic populations

Background Antiretroviral therapy (ART) has led to major improvements in the health of HIV infected populations Key indicators of this success include the proportion of patients on therapy with viral load (VL) <50 copies/mL and the proportion of all patients with a low CD4 count (<200 /mm 3 ) However, an increasing number of patients have experienced extensive triple class failure (ETCF)

Objectives To present trends over time in key indicators of treatment success and failure in the UK CHIC Study To estimate similar UK wide trends

Methods (1) The number of patients under follow-up in UK CHIC in each year from was calculated Patients were defined to be ART experienced in a given year if they had started ART before July 1st The proportion of patients with CD4 count <200 cells/mm 3 and VL <50 copies/mL on July 1st of each year was also calculated

Methods (2) Virologic failure of a drug was defined if a viral load >500 copies/mL was measured in an individual, despite at least 6 months of continuous use of the drug Extensive triple class failure (ETCF) was defined as failure of at least 3 NRTIs, an NNRTI and a PI/r CHIC estimates (risk group specific) were multiplied up to UK-wide estimates based on the breakdown of risk group from SOPHID

UK CHIC – 12 Centres CentreNumber of patients Brighton2,772 Mortimer Market/Archway5,904 St. Mary’s5,188 Kings3,461 Chelsea and Westminster10,286 Barts and the London3,717 Royal Free4,150 Edinburgh Western General1,012 Homerton1,247 North Middlesex1,494 Bristol1.026 Leicester625 Number of patients included in dataset - Before de-duplication40,882 - After de-duplication35,377

Characteristics of cohort n% Total number of patients Sex:Female Risk group:MSM IDU Heterosexual Other/not known Ethnicity:White Black African Other Not known Median (IQR) age at first entry into cohort (years):

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Patients under follow up in UK CHIC No. under follow-up % Male % MSM % Heterosexual ART experienced (N) % NNRTI experienced % PI experienced % 3-class experienced

Proportion of patients with current CD4 <200 cells/mm 3 and proportion of patients on HAART with VL<50 copies/ml

ART regimens received – all patients under follow up

ART regimens received – ART regimens received – ART-naïve patients, CD4 >200 cells/mm 3 at start

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL >50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

Estimated UK trends Year No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml % CD4<200 cells/mm 3 % ETCF (N) Of which VL <50 copies/ml %

ETCF in the UK

Summary ART success has improved markedly over the period with around 87% of patients now having a VL <50 copies/mL Over 90% of all patients now have a CD4 count above the particularly high risk level of 200 cells/mm 3 The absolute number of patients with ETCF is increasing However, the proportion of such patients who have VL >50 copies/ml is decreasing so the absolute number of patients with ETCF and detectable virus is no longer increasing

Research Department of Infection and Population Health, UCL Medical School: Caroline Sabin, Teresa Hill, Loveleen Bansi, Andrew Phillips, Susie Huntington Medical Research Council Clinical Trials Unit (MRC CTU): Abdel Babiker, David Dunn, Adam Glabay, Kholoud Porter Brighton and Sussex University Hospitals NHS Trust : Martin Fisher, Duncan Churchill, Nicky Perry, Anthony Pullin Chelsea and Westminster NHS Trust: Brian Gazzard, Steve Bulbeck, Jemima Clarke, Sundhiya Mandalia Kings College London School of Medicine, GKT Hospitals: Frank Post, Philippa Easterbrook, Yasar Khan, Paragi Patel, Fatimah Karim, Stephen Duffell, Fowzia Ibrahim Mortimer Market Centre, UCL Medical School: Richard Gilson, Shuk-Li Man, Ian Williams Royal Free NHS Trust/UCL Medical School: Margaret Johnson, Clinton Chaloner, Helen Grabowska, Fiona Lampe, Dewi Ismajani Puradiredja, Mike Youle, Colette Smith Imperial College Healthcare NHS Trust: John Walsh, Nicky Mackie, Alan Winston, Christian Kemble, Jonathan Weber Barts and the London NHS Trust: Chloe Orkin, Kevin Jones, Rachel Thomas Homerton University Hospital NHS Trust: Jane Anderson, Sajid Munshi The Lothian University Hospital NHS Trust: Clifford Leen, Alan Wilson North Middlesex University Hospital NHS Trust: Achim Schwenk, Jonathan Ainsworth Health Protection Agency Centre for Infections: Valerie Delpech North Bristol NHS Trust: Mark Gompels, Debbie Dooley UK CHIC is funded by the UK Medical Research Council UK CHIC: Acknowledgements