The current efficacy of ARV in keeping viral loads down – the

population perspectiveValerie Delpech and Alison Brown

Overview

• Current levels of ARV coverage• Patients eligible for ARV remaining untreated• Among the treated:– Predictors for sub-optimal adherence– Predictors for short term virological failure

• Surveillance perspective: HAS or CAN have an impact on transmission?

ARV coverage: UK

Proportion of patients with CD4<350 not receiving ARV

Proportion of patients with CD4<350 cells not receiving ARV: 2009

Age groupDiagnosed <1

yearDiagnosed >1

year

15-24 54% 33%

25-49 28% 16%

50+ 25% 7%

Total 32% 15%Ethnicity, HIV exposure and residential deprivation not significant in multi-variate analysis

Clinical outcomesFour outcomes have been developed to monitor key aspects of treatment and care:

•Outcome 1 - time between HIV diagnosis & the patient being integrated in to HIV care•Outcome 2 - effectiveness of HIV therapy after one year treatment•Outcome 3 - disease stage of patients after one year in HIV related care•Outcome 4 - survival of patients recently diagnosed, adjusted by disease stage at diagnosis

Out come 2 - results

• Exclusions: pregnant women

• National - 2009: - 5% (318)of patients discontinued ARV within 1 year of starting ARV- 15% (834) of patients had virological failure 1 after starting ARV

VL<50 VL<200

London - 2008 90% 95%

Discontinued ARV12 months after initiation: 2009

Age at ARV initiation9% aged 16-24 years

vs4% at 55+ years

CD4 at initiation5% at <200 cells

vs 10% at >500 cells

Virological failure12 months after initiation: 2009

Age at initiation

22% at 16-24 years vs

12% at 55+ years

CD4 count at ARV initiation

20% at <200 cells vs

16% at >500 cells

Viral load at ARV initiation

5% at <50 copiesvs

20% at over >100,000 copies

Number of MSM HIV testing, newly diagnosed and receiving ARV

Number of HIV-infected MSM in the UK, by CD4 count

Summary

• One in four diagnosed HIV-infected patients eligible for ARV not receiving it; especially younger patients

• 1 in 20 patients starting ARV discontinue it within 12 months

• Almost 1 in 7 patients receiving ARV for one year don’t reach VL<50

• A quarter of MSM are undiagnosed (high viral load)

Thank you