Melanie Stecher1,2, Philipp Schommers3,4, Daniel Schmidt5,6, Christian Kollan5, Barbara Gunsenheimer-Bartmeyer5, Clara Lehmann3,4, Martin Platten3, Gerd Fätkenheuer3,4, Jörg Janne Vehreschild7,8. 1. Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany. melanie.stecher@uk-koeln.de. 2. Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany. melanie.stecher@uk-koeln.de. 3. Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany. 4. Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany. 5. Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. 6. Charité - University Medicine Berlin, Berlin, Germany. 7. Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany. joerg.vehreschild@uk-koeln.de. 8. Partner Site Cologne-Bonn, German Center for Infection Research (DZIF), Cologne, Germany. joerg.vehreschild@uk-koeln.de.
Abstract
PURPOSE: The aim of the study was to assess guideline adherence to combined antiretroviral therapy (ART) in the German ClinSurv HIV Cohort and the real-life impact of the Strategic Timing of Antiretroviral Therapy (START) study, to identify patients not treated as recommended by new guidelines. METHODS: We used data from the multicenter ClinSurv cohort of the Robert-Koch-Institute (RKI) between 1999 and 2016. Inclusion criteria were people living with HIV/AIDS, ≥ 18 years of age and cART naïve at the first visit (FV). Adherence was defined as starting cART within 6 months of crossing the CD4+ T cell threshold as suggested by the German-Austrian treatment guidelines. Logistic regression was used to identify factors associated with non-adherence. RESULTS: 11,817 patients met the inclusion criteria. We observed an overall adherence rate of 60%, in patients with treatment indication who started cART timely between 2002 and 2015. Adherence rate increased constantly, demonstrating a potential increase in patients, with treatment indication, starting cART within 6 months of presentation from 55% in 2008 to 94% in 2015. Patients reporting injection drug use (OR 2.18, 95% CI 1.70-2.95) and patients between 18 years and 39 years of age at the time of their first visit (OR 2.89, 95% CI 1.35-6.18) were identified as risk groups associated with non-adherence. CONCLUSION: The majority of patients below the CD4+ T cell count threshold of applicable guidelines initiated treatment within 6 months. We observed a slowly diminishing proportion of patients not starting cART timely. Delayed treatment was more frequent in patients reporting injection drug use.
PURPOSE: The aim of the study was to assess guideline adherence to combined antiretroviral therapy (ART) in the German ClinSurv HIV Cohort and the real-life impact of the Strategic Timing of Antiretroviral Therapy (START) study, to identify patients not treated as recommended by new guidelines. METHODS: We used data from the multicenter ClinSurv cohort of the Robert-Koch-Institute (RKI) between 1999 and 2016. Inclusion criteria were people living with HIV/AIDS, ≥ 18 years of age and cART naïve at the first visit (FV). Adherence was defined as starting cART within 6 months of crossing the CD4+ T cell threshold as suggested by the German-Austrian treatment guidelines. Logistic regression was used to identify factors associated with non-adherence. RESULTS: 11,817 patients met the inclusion criteria. We observed an overall adherence rate of 60%, in patients with treatment indication who started cART timely between 2002 and 2015. Adherence rate increased constantly, demonstrating a potential increase in patients, with treatment indication, starting cART within 6 months of presentation from 55% in 2008 to 94% in 2015. Patients reporting injection drug use (OR 2.18, 95% CI 1.70-2.95) and patients between 18 years and 39 years of age at the time of their first visit (OR 2.89, 95% CI 1.35-6.18) were identified as risk groups associated with non-adherence. CONCLUSION: The majority of patients below the CD4+ T cell count threshold of applicable guidelines initiated treatment within 6 months. We observed a slowly diminishing proportion of patients not starting cART timely. Delayed treatment was more frequent in patients reporting injection drug use.
Authors: Melanie Stecher; Philipp Schommers; Christian Kollan; Matthias Stoll; Frieder Kuhlendahl; Hans-Jürgen Stellbrink; Jan-Christian Wasmuth; Christoph Stephan; Laura Hamacher; Clara Lehmann; Christoph Boesecke; Johannes Bogner; Stefan Esser; Carlos Fritzsche; Annette Haberl; Dirk Schürmann; Olaf Degen; Heinz-August Horst; Christian Hoffmann; Björn Jensen; Carolynne Schwarze-Zander; Martin Platten; Gerd Fätkenheuer; Daniel Schmidt; Barbara Gunsenheimer-Bartmeyer; Jörg Janne Vehreschild Journal: Infection Date: 2020-07-01 Impact factor: 3.553
Authors: Max J Hassenstein; Ghazal Aarabi; Peter Ahnert; Heiko Becher; Claus-Werner Franzke; Julia Fricke; Gérard Krause; Stephan Glöckner; Cornelia Gottschick; André Karch; Yvonne Kemmling; Tobias Kerrinnes; Berit Lange; Rafael Mikolajczyk; Alexandra Nieters; Jördis J Ott; Wolfgang Ahrens; Klaus Berger; Claudia Meinke-Franze; Sylvia Gastell; Kathrin Günther; Karin Halina Greiser; Bernd Holleczek; Johannes Horn; Lina Jaeschke; Annika Jagodzinski; Lina Jansen; Carmen Jochem; Karl-Heinz Jöckel; Rudolf Kaaks; Lilian Krist; Oliver Kuß; Susan Langer; Nicole Legath; Michael Leitzmann; Wolfgang Lieb; Markus Loeffler; Nina Mangold; Karin B Michels; Christa Meisinger; Nadia Obi; Tobias Pischon; Tamara Schikowski; Sabine Schipf; Matthias B Schulze; Andreas Stang; Sabina Waniek; Kerstin Wirkner; Stefan N Willich; Stefanie Castell Journal: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz Date: 2020-04 Impact factor: 1.513
Authors: Georg Härter; Christoph D Spinner; Julia Roider; Markus Bickel; Ivanka Krznaric; Stephan Grunwald; Farhad Schabaz; Daniel Gillor; Nils Postel; Matthias C Mueller; Markus Müller; Katja Römer; Knud Schewe; Christian Hoffmann Journal: Infection Date: 2020-05-11 Impact factor: 3.553