ATV/r-based regimens: durable virological suppression and good tolerability as switch strategy from NNRTI-containing regimens in a real-life cohort

Current therapeutic options for the treatment of HIV provide high rates of virological suppression and good tolerability. However, as long-term treatment success has become a realistic goal, data evaluating the long-term efficacy and safety of switching strategies become more needed. The purpose of this sub-analysis is to describe the long-term outcomes of ATV/r regimens after switching from combinations containing non-nucleoside reverse transcriptase inhibitor (NNRTI) in a clinical setting. Non-comparative, retrospective study including data from 3 European databases (France – DatAids, Germany-KompNet, Sweden-InfCare). Data from antiretroviral (ARV)-experienced adults starting an ATV/r-regimen between October 2004-March 2007 were extracted every 6-months (maximum follow-up 5 years). Time to virological failure (VF) was analysed by the Kaplan-Meier method. Reasons for discontinuation and safety data were also collected. Of 1294 patients analysed, 250 switched from a NNRTI-based regimen. Patients were predominantly male (74%); median age 42 years (min, max: 23, 85); prior ARV exposure: median 5.0 years. At baseline (BL), 56% of patients had HIV-1 RNA<500 c/mL and 31% had<50 c/mL; median (min, max) CD4 cell count: 388 (6, 1299) cells/mm3. After 3-year follow-up, the probability of not having VF was 79% (95% CI 65–88%) and 62% (95% CI 52%–70%) for patients with BL HIV-1 RNA<or≥50 c/mL, respectively. The most frequent reasons for discontinuation were “unknown” (18%) and adverse events (8%). Hyperbilirubinemia was reported as reason for discontinuation in only 2 patients. In a clinical setting, switching from NNRTI to ATV/r-based regimen is associated with sustained virological suppression and good tolerability

Auditing HIV testing rates across Europe: results from the HIDES 2 Study

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested

Proportion with high HIV+ rate (>0.1%) across regions and ICs.

<p>The figure shows the audits with HIV positive rate < and >0.1% by region and by Indicator Condition (IC).</p

Potential Missed HIV Diagnoses, Including Upper and Lower Range.

<p>Potential Missed HIV Diagnoses, Including Upper and Lower Range.</p

Summary of Audit Results.

<p>¹calculated for 41 audits.</p><p>²calculated for 40 audits.</p><p>³calculated for 48 audits; one centre reported doing no tests and therefore no valid denominator</p><p>Summary of Audit Results.</p

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control