Ege university HIV- cohort antiretroviral treatment initiation and switch strategies: Changes in time

Background: The main goal of the study was to analyze the treatment initiation criteria of HIV/AIDS patients and changes in the treatment approach with regard to compatibility with the recommendations in the major guidelines. Secondary goals were to analyze the epidemiological features, clinical and laboratory findings and factors affecting survival among HIV/AIDS patients. Materials/Methods: The study included patients presenting to the Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University between January 1986 and December 2015. Only 431 cases followed-up between 1996 and 2015 were included because the medical files of earlier patients were not accessible. The data were analyzed and compared in two time periods (1996-2005 and 2006-2015). Results: Overall 80% of the patients were male; median age (min; max) was 36.43 (17; 77) years. The most common routes of transmission were heterosexual (52%) and sex between men (34.1%). At baseline, 26.8% of the cases had stage 1, 42.9% stage 2 and 30.3% stage 3 disease. While a higher number of patients with stage 3 disease presented to the clinic in the first decade of the study, there were more stage 1 or 2 patients in the second decade (p=0.00). The median (min; max) number of CD4 T lymphocytes at baseline was 160 (3; 650) cells/mm3 and 355 (0; 1800) cells/mm3 in the first and second decades, respectively (p=0.00). While 94.2% of the patients initiated treatment, 5.8% were followed up without treatment. In the first and second decades, the most common treatment regimens were zidovudine/lamivudine + nevirapine (26.5%) and tenofovir disoproxil fumarate/emtricitabine + lopinavir/ritonavir (31.3%), respectively. Virologic success at 6 months of treatment and throughout the total follow-up time was achieved in 70.1% and 78.1%, respectively. There was a significant difference (p=0.004) between two time periods in terms of achieving undetectable HIV RNA levels. Overall antiretroviral treatment was switched in 38.9% of the cases; the most common reason (48%) was adverse events. AIDS-defining disease developed in 12.9% of the cases; 52.6% and 11% of the patients had AIDS-defining disease in the first and second decades, respectively (p=0.01). The most common AIDS-defining disease was Mycobacterium tuberculosis (38%). Non-adherence to treatment was 11.6%. Overall, 60.8% of 384 cases with available data developed adverse events with hyperlipidemia being the most common (60.2%). The death rate was 6.5%; 35.7% occurred in the first decade and 64.3% in the second decade. The two most common causes of death were lymphoma (14.3%) and tuberculosis (10.9%). The estimated survival time was 272 months (95% confidence interval 225-320). Inability to achieve undetectable HIV RNA levels after antiretroviral treatment, the presence of an AIDS-defining disease and a baseline CD4 T lymphocyte count of <200 cells/mm3 was inversely correlated with survival time. Conclusions: The management of HIV–infected patients in the Ege University cohort is in line with the recommendations in major guidelines. In the second decade of the cohort the rate of retention in care seem to have reached the UNAIDS 90-90-90 targets and the rates of treatment initiation and virologic success are above the target. Key words: HIV, antiretroviral therapy, survival