Published in:
01-10-2014 | Clinical and Epidemiological Study
Clinical course and quality of care in ART-naïve patients newly presenting in a HIV outpatient clinic
Published in: Infection | Issue 5/2014
Login to get accessAbstract
Objectives
Little data exist about the quality of care for HIV-infected subjects in Germany. We investigated the clinical course of HIV-infected subjects newly presenting in our HIV outpatient clinic.
Methods
Antiretroviral therapy (ART)-naïve HIV-infected subjects presenting between 2007 and 2008 were followed until June 2012. Clinical data and laboratory parameters were collected prospectively and analysed retrospectively.
Results
From 281 subjects included, 34 patients (12 %) were lost to follow-up. 247 subjects remained, and 171 patients were followed for 1,497 days [1,121/1,726] (all data: median [interquartile range]). ART was started in 199 patients (81 %) 182 days [44/849] after HIV diagnosis, and all patients were treated according to European guidelines or within clinical trials. The CD4 cell count at first presentation was 320/µL [160/500] and declined to 210/µL [100/300] at ART start. 12 months thereafter, the CD4 cell count increased to 410/µL [230/545]. The HIV RNA was suppressed below 50 copies/mL after 108 days [63/173] in 182 patients (91 %). Initial ART was changed in 71 patients (36 %) after 281 days [99/718], in five patients (7 %) due to virological failure, in 66 patients (93 %) due to other reasons, e.g. side effects or patient’s request.
Conclusion
Two-thirds of the included patients were followed for more than 3 years, and ART was initiated in 81 % of the patients leading to complete virological suppression in most patients. Compliance of physicians with treatment guidelines was high. Late presentation with a severely compromised immune function remains a problem and impairs the otherwise good prognosis of HIV infection.