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

2. 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)

3. 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

4. Methods (1) The number of patients under follow-up in UK CHIC in each year from 2000-2008 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

5. 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

6. 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

7. Characteristics of cohort n% Total number of patients35377100.0 Sex:Female865924.5 Risk group:MSM1798450.8 IDU13964.0 Heterosexual1114931.5 Other/not known484813.7 Ethnicity:White1991256.3 Black African854324.2 Other471113.3 Not known22116.3 Median (IQR) age at first entry into cohort (years): 3024-36

8. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

9. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

10. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

11. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

12. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

13. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

14. Patients under follow up in UK CHIC 200020012002200320042005200620072008 No. under follow-up90081018411359127021391515212170221761217023 % Male838180787776 % MSM666462616059 5857 % Heterosexual232628303132 3332 ART experienced (N)69777907877598711092411977135661433613993 % NNRTI experienced6472767881 807981 % PI experienced635957545556 5856 % 3-class experienced3538 39 38

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

16. ART regimens received – all patients under follow up

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

18. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL >50 copies/ml % 24 404958

19. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

20. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

21. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

22. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

23. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

24. Estimated UK trends Year20002002200420062008 No. under follow-up20,38428,26537,99947,72356,433 On ART (N)14,00419,55827,03135,73543,635 VL<50 copies/ml %6067808587 CD4<200 cells/mm 3 %201513107 ETCF (N)13248398513751829 Of which VL <50 copies/ml % 24 404958

25. ETCF in the UK

26. Summary ART success has improved markedly over the period 2000-2008 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

27. 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