BACKGROUND: The success of clinical care for human immunodeficiency virus infection may vary across demographic groups, because of patient- and health care-related factors. METHODS: A total of 2386 patients sexually infected with the human immunodeficiency virus were seen in a London clinic from July 1, 1999, to December 31, 2004. We examined demographic variation and trends over time in the prevalence of the following: (1) a CD4 cell count of 200/microL or less; (2) a viral load of greater than 50 copies/mL among patients receiving antiretroviral therapy (ART); and (3) a viral load of greater than 50 copies/mL among patients receiving ART for 24 weeks or longer. RESULTS: Subjects were homosexual men (63.1%), white heterosexual men (4.3%) and women (5.1%), and black African or other ethnicity heterosexual men (10.2%) and women (17.3%). The CD4 cell count at the first clinic visit was highest among homosexual men and lowest among black African heterosexual men. From 1999 to 2004, ART use increased from 61.9% to 75.5%. The prevalence of a CD4 cell count of 200/microL or less decreased from 19.6% to 9.0%. The prevalence of a viral load of greater than 50 copies/mL decreased from 36.9% to 14.5% among patients receiving ART, and from 31.2% to 10.1% among patients receiving ART for 24 weeks or longer. Demographic variation in the prevalence of each outcome was apparent among men throughout the period: homosexual men had the most favorable profile, and black African heterosexual men had the least favorable profile. Differences were much greater for low CD4 cell count than for raised viral load while receiving ART. There was no consistent demographic variation among women. Favorable trends over time occurred within each demographic group, and were as strong among black African patients as among other subgroups. CONCLUSIONS: The success of clinical care for human immunodeficiency virus infection increased substantially from 1999 to 2004 in this routine clinic population. All demographic subgroups benefited from improvements, despite ongoing differences in the prevalence of immunosuppression.
BACKGROUND: The success of clinical care for human immunodeficiency virus infection may vary across demographic groups, because of patient- and health care-related factors. METHODS: A total of 2386 patientssexually infected with the human immunodeficiency virus were seen in a London clinic from July 1, 1999, to December 31, 2004. We examined demographic variation and trends over time in the prevalence of the following: (1) a CD4 cell count of 200/microL or less; (2) a viral load of greater than 50 copies/mL among patients receiving antiretroviral therapy (ART); and (3) a viral load of greater than 50 copies/mL among patients receiving ART for 24 weeks or longer. RESULTS: Subjects were homosexual men (63.1%), white heterosexual men (4.3%) and women (5.1%), and black African or other ethnicity heterosexual men (10.2%) and women (17.3%). The CD4 cell count at the first clinic visit was highest among homosexual men and lowest among black African heterosexual men. From 1999 to 2004, ART use increased from 61.9% to 75.5%. The prevalence of a CD4 cell count of 200/microL or less decreased from 19.6% to 9.0%. The prevalence of a viral load of greater than 50 copies/mL decreased from 36.9% to 14.5% among patients receiving ART, and from 31.2% to 10.1% among patients receiving ART for 24 weeks or longer. Demographic variation in the prevalence of each outcome was apparent among men throughout the period: homosexual men had the most favorable profile, and black African heterosexual men had the least favorable profile. Differences were much greater for low CD4 cell count than for raised viral load while receiving ART. There was no consistent demographic variation among women. Favorable trends over time occurred within each demographic group, and were as strong among black African patients as among other subgroups. CONCLUSIONS: The success of clinical care for human immunodeficiency virus infection increased substantially from 1999 to 2004 in this routine clinic population. All demographic subgroups benefited from improvements, despite ongoing differences in the prevalence of immunosuppression.
Authors: Margaret T May; Robert S Hogg; Amy C Justice; Bryan E Shepherd; Dominique Costagliola; Bruno Ledergerber; Rodolphe Thiébaut; M John Gill; Ole Kirk; Ard van Sighem; Michael S Saag; Gemma Navarro; Paz Sobrino-Vegas; Fiona Lampe; Suzanne Ingle; Jodie L Guest; Heidi M Crane; Antonella D'Arminio Monforte; Jörg J Vehreschild; Jonathan A C Sterne Journal: Int J Epidemiol Date: 2012-11-12 Impact factor: 7.196
Authors: Rebecca K Lodwick; Caroline A Sabin; Kholoud Porter; Bruno Ledergerber; Ard van Sighem; Alessandro Cozzi-Lepri; Pavel Khaykin; Amanda Mocroft; Lisa Jacobson; Stephane De Wit; Niels Obel; Antonella Castagna; Jan-Christian Wasmuth; John Gill; Marina B Klein; Stephen Gange; Melchor Riera; Cristina Mussini; Félix Gutiérrez; Giota Touloumi; Patrizia Carrieri; Jodie L Guest; Norbert H Brockmeyer; Andrew N Phillips Journal: Lancet Date: 2010-07-15 Impact factor: 79.321
Authors: Mattia C F Prosperi; Simona Di Giambenedetto; Iuri Fanti; Genny Meini; Bianca Bruzzone; Annapaola Callegaro; Giovanni Penco; Patrizia Bagnarelli; Valeria Micheli; Elisabetta Paolini; Antonio Di Biagio; Valeria Ghisetti; Massimo Di Pietro; Maurizio Zazzi; Andrea De Luca Journal: BMC Med Inform Decis Mak Date: 2011-06-14 Impact factor: 2.796
Authors: Andrew N Phillips; Valentina Cambiano; Fumiyo Nakagawa; Alison E Brown; Fiona Lampe; Alison Rodger; Alec Miners; Jonathan Elford; Graham Hart; Anne M Johnson; Jens Lundgren; Valerie C Delpech Journal: PLoS One Date: 2013-02-15 Impact factor: 3.240