Alison R McClean1, Jason Trigg2, Claudette Cardinal3, Mona Loutfy4, Curtis Cooper5, Abigail Kroch6, Mostafa Shokoohi7, Nimâ Machouf8, Réjean Thomas9, Marina B Klein10, Deborah V Kelly11, Alexander Wong12, Stephen Sanche12, Julio S G Montaner13, Robert S Hogg14. 1. , PharmD, is with the British Columbia Centre for Excellence in HIV/AIDS and The University of British Columbia, Vancouver, British Columbia. 2. , MA, is with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia. 3. is with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia. 4. , MD, MPH, is with the Maple Leaf Medical Clinic, the Women's College Research Institute, and the University of Toronto, Toronto, Ontario. 5. , MD, MSc, is with the Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, Ontario. 6. , MPH, PhD, is with the University of Toronto, Toronto, Ontario. 7. , PhD, is with the University of Toronto, Toronto, Ontario. 8. , PhD, is with the Clinique de Médecine Urbaine du Quartier Latin, Montréal, Quebec. 9. , MD, was, at the time this study was performed, with the Clinique de Médecine Urbaine du Quartier Latin, Montréal, Quebec. He is now with the Clinique médicale l'Actuel, Montréal, Quebec. 10. , MD, MSc, is with the McGill University Health Centre, Montréal, Quebec. 11. , PharmD, is with Memorial University of Newfoundland, St John's, Newfoundland and Labrador. 12. , MD, is with the University of Saskatchewan, Regina, Saskatchewan. 13. , MD, is with the British Columbia Centre for Excellence in HIV/AIDS and The University of British Columbia, Vancouver, British Columbia. 14. , PhD, is with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, and Simon Fraser University, Burnaby, British Columbia.
Abstract
Background: Advances in treatment have turned HIV from a terminal illness to a more manageable condition. Over the past 20 years, there have been considerable changes to HIV treatment guidelines, including changes in preferred antiretrovirals and timing of initiation of combination antiretroviral therapy (cART). Objective: To examine real-world trends in cART utilization, viral control, and immune reconstitution among people living with HIV in Canada. Methods: Data were obtained from the Canadian Observational Cohort (CANOC). CANOC participants were eligible if they were antiretroviral therapy-naive at entry and initiated 3 or more antiretrovirals on or after January 1, 2000; if they were at least 18 years of age at treatment initiation; if they were residing in Canada; and if they had at least 1 viral load determination and CD4 count within 1 year of CANOC entry. Baseline and annual mean CD4 counts were categorized as less than 200, 200-350, 351-500, and more than 500 cells/mm3. Annual mean viral loads were reported as suppressed (< 50 copies/mL), low (50-199 copies/mL), or high detectable (≥ 200 copies/mL). The cART regimens were reported yearly. Results: All CANOC participants were included (n = 13 040). Over the study period, the proportion of individuals with an annual mean CD4 count above 500 cells/mm3 increased from 16.3% to 65.8%, while the proportion of individuals with an undetectable mean viral load increased from 10.6% to 83.2%. As of 2007, the most commonly prescribed 2-agent nucleoside reverse transcriptase inhibitor backbone was tenofovir disoproxil fumarate and emtricitabine. In terms of third agents, non-nucleoside reverse transcriptase inhibitors were the most common class in the periods 2000-2003 and 2014-2015, protease inhibitors were most common in the period 2004-2013, and integrase inhibitors were most common in 2016. Conclusions: Concordance with treatment guidelines was demonstrated over time with respect to cART prescribing and immunologic and virologic response. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Background: Advances in treatment have turned HIV from a terminal illness to a more manageable condition. Over the past 20 years, there have been considerable changes to HIV treatment guidelines, including changes in preferred antiretrovirals and timing of initiation of combination antiretroviral therapy (cART). Objective: To examine real-world trends in cART utilization, viral control, and immune reconstitution among people living with HIV in Canada. Methods: Data were obtained from the Canadian Observational Cohort (CANOC). CANOC participants were eligible if they were antiretroviral therapy-naive at entry and initiated 3 or more antiretrovirals on or after January 1, 2000; if they were at least 18 years of age at treatment initiation; if they were residing in Canada; and if they had at least 1 viral load determination and CD4 count within 1 year of CANOC entry. Baseline and annual mean CD4 counts were categorized as less than 200, 200-350, 351-500, and more than 500 cells/mm3. Annual mean viral loads were reported as suppressed (< 50 copies/mL), low (50-199 copies/mL), or high detectable (≥ 200 copies/mL). The cART regimens were reported yearly. Results: All CANOC participants were included (n = 13 040). Over the study period, the proportion of individuals with an annual mean CD4 count above 500 cells/mm3 increased from 16.3% to 65.8%, while the proportion of individuals with an undetectable mean viral load increased from 10.6% to 83.2%. As of 2007, the most commonly prescribed 2-agent nucleoside reverse transcriptase inhibitor backbone was tenofovir disoproxil fumarate and emtricitabine. In terms of third agents, non-nucleoside reverse transcriptase inhibitors were the most common class in the periods 2000-2003 and 2014-2015, protease inhibitors were most common in the period 2004-2013, and integrase inhibitors were most common in 2016. Conclusions: Concordance with treatment guidelines was demonstrated over time with respect to cART prescribing and immunologic and virologic response. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
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