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BHIVA: UK HIV patients remained on first combination for almost seven years during early-HAART era
Michael Carter, Monday, April 03, 2006
HIV-positive patients in the United Kingdom remained on their first potent antiretroviral combination a median of seven years, according to data presented to the Twelfth Annual Conference of the British HIV Association in Brighton on March 31st. The investigators calculated that the cost of treatment and care received during this period was a little over £112,000.

Investigators wished to determine the median duration of first-, second- and third-line potent antiretroviral regimens used at 27 UK HIV clinics treating over 22,000 individuals between 1996 (when the use of triple drug combinations first became widespread) and 2002. The researchers also wished to establish the reasons for first treatment failure and the cost of hospital treatment and care.

A total of 3,647 patients received first-line antiretroviral therapy during this period. The median CD4 cell count when HIV therapy was started was 270 cells/mm3 and median viral load was 75,000 copies/ml, with 11% of individuals having an AIDS diagnosis prior to commencing treatment.

The median duration of first-line therapy was 6.7 years. Individuals who started antiretroviral treatment with a CD4 cell count below 170 cells/mm3 (p = 0.002), who had a prior AIDS-defining illness (p < 0.001), and who took an unboosted protease inhibitor rather than a non-nucleoside reverse transcriptase inhibitor (p < 0.001) remained on their first combination for a shorter period. Immunological or virological failure, or clinical progression was experienced by 42% of those whose first-line therapy failed.

The average cost of HIV treatment and care from the initiation to failure of first-line treatment was £112,158.

When the investigators turned their attention to second-line therapy, they established that the 1,037 individuals who received it did so for a median duration of 4.3 years. Virological or immunological failure or clinical progression was the reason for second-line failure in 52% of patients. The average cost of second-line treatment and care was £71,000.

The median duration of third-line therapy was 4.2 hours and cost £70,000. Once again, virological or immunological failure, or clinical progression accounted for approximately half (53%) of treatment failures.

The investigators conclude that as only 40 to 50% of all treatment failures were due viral load rebounding, CD4 cell count falling or disease progressing, that side-effects were likely to be the major cause of treatment failure.

Reference

Mandilia S et al. Cause and time to treatment failure of HAART and cost of care in UK NPMS-HHC clinics, 1996 – 2002. HIV Med 7 (supplement 1), abstract 033, 2006.