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The current efficacy of ARV in keeping viral loads down – the population perspective

The current efficacy of ARV in keeping viral loads down – the population perspective. Valerie Delpech and Alison Brown. Overview. Current levels of ARV coverage Patients eligible for ARV remaining untreated Among the treated: Predictors for sub-optimal adherence

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The current efficacy of ARV in keeping viral loads down – the population perspective

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  1. The current efficacy of ARV in keeping viral loads down – the population perspective Valerie Delpech and Alison Brown

  2. Overview • Current levels of ARV coverage • Patients eligible for ARV remaining untreated • Among the treated: • Predictors for sub-optimal adherence • Predictors for short term virological failure • Surveillance perspective: HAS or CAN have an impact on transmission?

  3. ARV coverage: UK

  4. Proportion of patients with CD4<350 not receiving ARV

  5. Proportion of patients with CD4<350 cells not receiving ARV: 2009 Ethnicity, HIV exposure and residential deprivation not significant in multi-variate analysis

  6. Clinical outcomes Four outcomes have been developed to monitor key aspects of treatment and care: Outcome 1 - time between HIV diagnosis & the patient being integrated in to HIV care Outcome 2 - effectiveness of HIV therapy after one year treatment Outcome 3 - disease stage of patients after one year in HIV related care Outcome 4 - survival of patients recently diagnosed, adjusted by disease stage at diagnosis

  7. Out come 2 - results • Exclusions: pregnant women • National - 2009: - 5% (318)of patients discontinued ARV within 1 year of starting ARV - 15% (834) of patients had virological failure 1 after starting ARV

  8. Discontinued ARV12 months after initiation: 2009

  9. Virological failure12 months after initiation: 2009

  10. Number of MSM HIV testing, newly diagnosed and receiving ARV

  11. Number of HIV-infected MSM in the UK, by CD4 count

  12. Summary • One in four diagnosed HIV-infected patients eligible for ARV not receiving it; especially younger patients • 1 in 20 patients starting ARV discontinue it within 12 months • Almost 1 in 7 patients receiving ARV for one year don’t reach VL<50 • A quarter of MSM are undiagnosed (high viral load)

  13. Thank you

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