17th Report of the Austrian HIV Cohort Study by AGES

HIV/AIDS IN AUSTRIA 2010

17th REPORT OF THE AUSTRIAN HIV COHORT STUDY Austrian Agency for Health and Food Safety www.ages.at

FOREWORD

Alois Stรถger Bundesminister fรผr Gesundheit )HGHUDO 0LQLVWHU IRU +HDOWK Vorwort von Bundesminister Alois Stรถger fรผr den Bericht der รถsterreichischen HIV-Kohortenstudie +,9 LQยฟ]LHUWH RGHU DQ $LGV HUNUDQNWH 0HQVFKHQ KDEHQ HLQ VFKZHUHV 6FKLFNVDO ]X WUDJHQ ยฑ ]X GHQ VFKZHUZLHJHQGHQ JHVXQGKHLWOLFKHQ 3UREOHPHQ NRPPW RIW HLQH JHVHOOVFKDIWOLFKH 6WLJPDWLVLHUXQJ KLQ]X (V LVW EHGDXHUOLFK GDVV +,9 ,Qยฟ]LHUWH XQG $,'6 .UDQNH LQ XQVHUHU *HVHOOVFKDIW QRFK LPPHU 9RUXUWHLOHQ DXVJHVHW]W VLQG 8PVR ZLFKWLJHU LVW HV GDVV VLFK GLHVH 0HQVFKHQ DXI GDV HUVWNODVVLJH |VWHUUHLFKLVFKH *HVXQGKHLWVZHVHQ YHUODVVHQ N|QQHQ 'DVV GHP VR LVW EHZHLVW GHU YRUOLHJHQGH %HULFKW GHU |VWHUUHLFKLVFKHQ +,9 .RKRUWHQVWXGLH :DV LQ DQGHUHQ /lQGHUQ RIW ]X HLQHU XQ]XPXWEDUHQ ยฟQDQ]LHOOHQ %HODVWXQJ YRQ 3DWLHQWLQQHQ XQG 3DWLHQWHQ Iย KUW ย EHUQLPPW LQ gVWHUUHLFK GLH VROLGDULVFKH .UDQNHQYHUVLFKHUXQJ 7HVWXQJ XQG 7KHUDSLH VLQG ZHLWJHKHQG NRVWHQIUHL 1HXHVWH XQG ZLUNVDPVWH %HKDQGOXQJVVWUDWHJLHQ JDUDQWLHUHQ GHQ (UNUDQNWHQ HLQ ZHLWJHKHQG QRUPDOHV /HEHQ LQ KRKHU 4XDOLWlW ,Q gVWHUUHLFK JLEW HV ยฑ LP *HJHQVDW] ]X DQGHUHQ /lQGHUQ ยฑ NHLQH 0HOGHSร LFKW Iย U +,9 'DV KDW VLFK QLFKW DOV 1DFKWHLO HUZLHVHQ ]XPDO XQVHU *HVXQGKHLWV XQG 6R]LDOZHVHQ Iย U HLQH FKURQLVFKH EHKDQGHOEDUH .UDQNKHLW RSWLPDO JHUย VWHW LVW +,9 XQG $,'6 Gย UIHQ IUHLOLFK QLFKW EDJDWHOOLVLHUW ZHUGHQ 'LHV LVW GHP PLW JURย HU $NULELH LP 9RUIHOG GHU :HOW $LGV .RQIHUHQ] LQ :LHQ HUVWHOOWHQ %HULFKW ]X HQWQHKPHQ LQ ZHOFKHP GLH $XWRULQQHQ XQG $XWRUHQ GDV YHUIย JEDUH 'DWHQPDWHULDO ]XVDPPHQJHIย KUW KDEHQ 'HQ $XWRU,QQHQ XQG GHQ 0LWDUEHLWHU,QQHQ GHU |VWHUUHLFKLVFKHQ +,9 %HKDQGOXQJV]HQWUHQ JHEย KUW GDIย U XQVHUH JDQ]H $QHUNHQQXQJ

Foreword from Federal Minister for Health Alois Stรถger for the Austrian HIV-Cohort Study 7KH IROORZLQJ UHSRUW FRQFHUQLQJ WKH $XVWULDQ +,9 &RKRUW 6WXG\ SURYHV RQFH PRUH WKDW $XVWULDQV OLYLQJ ZLWK +,9 DQG $,'6 FDQ UHO\ RQ WKHLU KHDOWK FDUH V\VWHP 8QOLNH WKH KLJK ยฟQDQFLDO EXUGHQ IRU SDWLHQWV LQ RWKHU FRXQWULHV WKH $XVWULDQ VRFLDO LQVXUDQFH V\VWHP DFFHSWV WKH LQFXUULQJ FRVWV DOPRVW IXOO\ 7HVWV DQG WKHUDSLHV DUH ODUJHO\ IUHH RI FRVW 7KH ODWHVW DQG PRVW HIIHFWLYH WUHDWPHQW VWUDWHJLHV DUH XWLOLVHG WR JXDUDQWHH SDWLHQWV D JRRG TXDOLW\ RI OLIH ,Q $XVWULD DV RSSRVHG WR RWKHU FRXQWULHV +,9 LV QRW D PDQGDWRULO\ QRWLยฟDEOH GLVHDVH 7KLV KDV QRW SURYHQ WR EH D GLVDGYDQWDJH VLQFH RXU KHDOWK DQG ZHOIDUH V\VWHPV DUH ZHOO HTXLSSHG WR KDQGOH DQ\ FKURQLF GLVHDVH 1RQHWKHOHVV WKH VLJQLยฟFDQFH RI +,9 DQG $,'6 VKRXOG QRW EH PLQLPL]HG ,Q DQWLFLSDWLRQ RI WKH :RUOG $,'6 &RQIHUHQFH LQ WKLV LV ZKDW LV WR EH FRQYH\HG WKURXJK WKLV PHWLFXORXV UHSRUW LQ ZKLFK WKH DXWKRUV KDYH FRPSLOHG DOO WKH DYDLODEOH GDWD )RU WKLV WKH DXWKRUV DQG WKH FR ZRUNHUV RI WKH $XVWULDQ +,9 WUHDWPHQW FHQWUHV UHFHLYH RXU GXH UHFRJQLWLRQ

DEFINITION OF THE COHORT PARTICIPANTS

RECRUITMENT AND FOLLOW-UP OF COHORT PARTICIPANTS

0RWKHU WR FKLOG WUDQVPLVVLRQ 1$7,21$/,7< $1' &28175< 2) %,57+ /,9,1* 3$57,&,3$176 +($/7+ ,1685$1&(

3529,'(56 2) +($/7+ &$5(

STAGE OF HIV DISEASE

/2:(67 (9(5 0($685(' &' &(// &2817 &855(17 &2+257 &/$66,),&$7,21 2) 7+( &855(17 &2+257 $&&25',1* 72 &'&

“ELITE-CONTROLLERS” AND “VIREMIA-CONTROLLERS” CO-INFECTIONS

78%(5&8/26,6 &855(17 &2+257 +(3$7,7,6 & &855(17 &2+257 +(3$7,7,6 % &855(17 &2+257 &+521,& +(3$7,7,6 % $1' &+521,& +(3$7,7,6 &

DEVELOPMENT OF THE HIV/AIDS EPIDEMIC OVER TIME

&DWHJRULHV RI KHWHURVH[XDO LQIHFWLRQ +,9 VXEW\SHV

+,9 1DWLRQDOLW\ +,9 GLDJQRVHV EHWZHHQ DQG 1DWLRQDOLW\ RI WKH KHWHURVH[XDOO\ LQIHFWHG

$FWLYH 6\SKLOLV SUHYDOHQFH 1HZ ³UHFHQW´ V\SKLOLV LQIHFWLRQV LQFLGHQFH

6<3+,/,6 0LVVLQJ YDOXHV DQG VWDWXV SRVW V\SKLOLV GLDJQRVHV FXUUHQW FRKRUW

*(1'(5 2) 7+( &855(17 &2+257 3$57,&,3$176 *(1'(5 $021* +(7(526(;8$//< $&48,5(' +,9 ,1)(&7,21 $*( 2) 7+( &855(17 &2+257 3$57,&,3$176 02'( 2) 75$160,66,21 2) 7+( +,9 ,1)(&7,21 $OO PRGHV RI WUDQVPLVVLRQ

DEMOGRAPHIC CHARACTERISTICS OF THE COHORT PARTICIPANTS

FINANCING

5,6. )$&7256 )25 12 )2//2: 83 ,1 7+( /$67 0217+6 &216758&7,21 2) $ ³&855(17 &2+257´

ORGANIZATION AND DEVELOPMENT OF THE AUSTRIAN HIV COHORT STUDY

INTRODUCTION

INDEX

8VH RI 3, 8VH RI HQWU\ IXVLRQ LQKLELWRUV

1XPEHU RI SDWLHQWV ZKR KDYH HYHU UHFHLYHG 157, 1157, DQG 3, GUXJV $57 6:,7&+(6 $1' ,17(55837,216 3(5 &$/(1'$5 <($5 5LVN IDFWRUV IRU WUHDWPHQW LQWHUUXSWLRQV VLQFH 5LVN IDFWRUV IRU WUHDWPHQW VZLWFKHV VLQFH ,1,7,$/ 7+(5$3< $)7(5 -8/< 5HJLPHQV RI WKH LQLWLDO WKHUDS\ 6ZLWFKLQJ RI $57 GXULQJ WKH ¿UVW \HDU RI WUHDWPHQW $QWLUHWURYLUDO GUXJV LQ WKH LQLWLDO WKHUDS\

0257$/,7< ,1 &20%,1$7,21 $57 (5$ 6,1&( &DXVHV RI GHDWK 'HDWK UDWH &' &(// &28176

BENEFITS OF ANTIRETROVIRAL THERAPY 0257$/,7< 2) 3$7,(176 :,7+ $,'6 6,1&(

'58* ',6&217,18$7,21 :,7+,1 <($56 2) 67$57,1* $ '58* 6,1&( )5(48(1&< 2) '58* '26,1*

8VH RI LQWHJUDVH LQKLELWRUV 8VH RI FRPPHUFLDO SUHSDUDWLRQV 8VH RI 157, FRPELQDWLRQV

8VH RI 157, 8VH RI 1157,

$'0,1,67(5(' $17,5(7529,5$/ '58*6

180%(5 2) 3$7,(176 21 $17,5(7529,5$/ 7+(5$3< $&&(66 72 $17,5(7529,5$/ 7+(5$3< 5LVN QRW WR UHFHLYH $57 GHVSLWH D &' QDGLU DQG RU $,'6 5LVN QRW WR UHFHLYH $57 GHVSLWH D &' QDGLU DQG RU $,'6 6XPPDU\ RI LQGLFDWRUV RI DFFHVV WR $57 DQG KHDOWK FDUH 5(*,0(16 2) 7+( $17,5(7529,5$/ 7+(5$3<

ANTIRETROVIRAL THERAPY (ART)

³5HFHQW´ LQIHFWLRQ WLPH RI LQIHFWLRQ NQRZQ RU HVWLPDWHG 8QNQRZQ WLPH RI LQIHFWLRQ QRW ´UHFHQW´

,V WKH +,9 WHVW XVHG HI¿FLHQWO\" ³(DUO\´ DQG ³ODWH´ GLDJQRVHV 5LVN IDFWRUV IRU DQ ³HDUO\´ GLDJQRVLV +,9 GLDJQRVLV 5LVN IDFWRUV IRU D ³ODWH´ GLDJQRVLV +,9 GLDJQRVLV 5LVN IDFWRUV IRU DQ ³DGYDQFHG´ GLDJQRVLV +,9 GLDJQRVLV 5LVN IDFWRUV IRU PRUWDOLW\ DIWHU WKH +,9 GLDJQRVLV 5LVN IDFWRUV IRU GHYHORSLQJ $,'6 HDUO\ LQWHUPHGLDWH GLDJQRVHV $,'6 +2: 0$1< +,9 ,1)(&7,216 $5( 7+(5( ,1 $8675,$" 75$160,66,21 2) '58* 5(6,67$17 +,9 1XPEHU RI SDWLHQWV ZLWK UHVLVWDQFH WHVW EHIRUH +,9 WKHUDS\

&2025%,',7,(6 0\RFDUGLDO LQIDUFWLRQ 6WURNH /LSRDWURSK\ /LSRDFFXPXODWLRQ 6\PSWRPDWLF K\SHUODFWDWHPLD

'HYHORSPHQW RI UHVLVWDQFH DIWHU LQLWLDO WKHUDS\ ZLWK 157, 3, 3DWLHQWV ZLWK FODVV UHVLVWDQFH FODVV UHVLVWDQFH LQ GLIIHUHQW SRSXODWLRQV 5LVN IDFWRUV IRU WKH GHYHORSPHQW RI FODVV UHVLVWDQFH

'HYHORSPHQW RI UHVLVWDQFH DIWHU LQLWLDO $57 ZLWK 157, 1157,

&XPXODWLYH UHVLVWDQFH UHODWHG WR GLIIHUHQW WLPH SHULRGV RI $57 LQLWLDWLRQ 3UREDELOLW\ RI GHYHORSPHQW RI UHVLVWDQFH $Q\ $57 UHJLPHQ $Q\ $57 UHJLPHQ DQG LQLWLDO $57 DIWHU -DQXDU\

5LVN IDFWRUV IRU GHYHORSLQJ D UHVLVWDQFH PXWDWLRQ RQ FRGRQ . 5

RI WKH 57 SDWLHQWV ZLWK SDVW RU SUHVHQW 157, XVH )UHTXHQF\ RI 1157, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV )UHTXHQF\ RI 3, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV 5HVLVWDQFH WR VLQJOH RU PXOWLSOH GUXJ FODVVHV 5HVLVWDQFH DFFRUGLQJ WR GHPRJUDSKLF FKDUDFWHULVWLFV

)5(48(1&< 2) 5(6,67$1&( )UHTXHQF\ RI 157, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV 2YHUYLHZ

RISKS OF ANTIRETROVIRAL THERAPY

'(),1,7,21 2) 5(6,67$1&( 81'(5 $57

+,9 51$ 9,5$/ /2$' /DVW +,9 51$ LQ WKH FXUUHQW FRKRUW 9LURORJLF UHVSRQVH \HDU DIWHU $57 LQLWLDWLRQ WR /DVW +,9 51$ RI SDWLHQWV RQ $57 /DVW +,9 51$ RI SDWLHQWV RQ $57 VWUDWLÂ¿HG E\ DJH DQG JHQGHU /DVW +,9 51$ RI SDWLHQWV RQ $57 DW GLIIHUHQW SRLQWV LQ WLPH /DVW +,9 51$ RI SDWLHQWV RQ $57 DFFRUGLQJ WR WUDQVPLVVLRQ ULVN 5LVN IDFWRUV IRU YLUDO UHSOLFDWLRQ 5LVN IDFWRUV IRU +,9 51$ Â&#x2022; FRSLHV PO RQ $57 5LVN IDFWRUV IRU +,9 51$ ! FRSLHV PO RQ $57

&' FHOO FRXQWV DW LQLWLDWLRQ RI $57 &' FHOO FRXQWV QDGLU DQG PRVW UHFHQW 2YHUYLHZ 0RVW UHFHQW &' FHOO FRXQW E\ GXUDWLRQ RI WKHUDS\ &' FHOOV ! Â&#x2014;O &' FHOOV ! Â&#x2014;O SDWLHQWV ZLWKRXW WUHDWPHQW LQWHUUXSWLRQV RQO\ 5LVN IDFWRUV IRU D &' FHOO FRXQW Â&#x2014;O RQ $57 ,QFUHDVH RI &' FHOOV GXULQJ $57

GLOSSARY AUSTRIAN HIV COHORT STUDY GROUP

SUMMARY

'LDEHWHV PHOOLWXV /LSLG PHWDEROLVP DEQRUPDOLWLHV FXUUHQW FRKRUW 5LVN IDFWRUV IRU FXUUHQW UHQDO LQVXIÂ¿FLHQF\ VWDJH 5LVN IDFWRUV IRU RVWHRSRURVLV

INTRODUC

:HDN RYHUEXUGHQHG LQIUDVWUXFWXUH LQ +,9 WUHDWPHQW FHQWUHV

&KHFNLQJ RI SODXVLELOLW\ RI WKH GDWD DIWHU HQWU\ LQ WKH GDWDEDVH 0HHWLQJ WKH UHTXLUHPHQWV RI ERWK FOLQLFDO SDWLHQW PDQDJHPHQW DQG VFLHQWL¿F GDWDEDVH

Special challenges for the HIV Patient Management System are:

RQ UHDGDELOLW\ RI GLDJQRVHV DQG WKHUDSLHV FUHDWLRQ RI PHGLFDO UHSRUWV SUHVFULSWLRQV WUDGH QDPHV SULQW RXW RI UHVXOWV HWF VFLHQWL¿F TXHULHV QHHG SUHFLVH FRGLQJ DQG FDWHJRUL]DWLRQ )XUWKHUPRUH WKH RSWLPL]DWLRQ RI LQGLYLGXDO SDWLHQW PDQDJHPHQW UHTXLUHV DQ RQJRLQJ DGMXVWPHQW WR WKH SURJUHVV RI LQIRUPDWLRQ WHFKQRORJ\ ZKHUHDV SXUHO\ VFLHQWL¿F GDWD EDVHV GR QRW KDYH VXFK WHFKQRORJLFDO UHQHZDO SUHVVXUH

PRXV FKDOOHQJH ZKLFK VFLHQWL¿F +,9 FRKRUWV LQ RWKHU FRXQWULHV KDYH QRW KDG WR GHDO ZLWK ,Q $XVWULD WKHUH ZDV QR DFFHSWDQFH IRU D SXUHO\ VFLHQWL¿F GDWD EDVH :KLOH IRU WKH FOLQLFDO SDWLHQW PDQDJHPHQW WKH IRFXV LV

2Q WKH RQH KDQG WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP IXO¿OV FRPSOH[ WDVNV IRU WKH FOLQLFDO PDQDJHPHQW RI +,9 LQIHFWHG SDWLHQWV DQG RQ WKH RWKHU KDQG LW DOORZV TXHULHV DQG DQDO\VHV WR EH SHUIRUPHG E\ WKH XVHUV ZLWKRXW UHVWULFWLRQV +RZHYHU WR DOORZ ERWK LQGLYLGXDO SDWLHQW PDQDJHPHQW DQG VFLHQWL¿F TXHULHV LV DQ HQRU-

DXWKRUL]HG XVHUV RQO\

,7 GHSDUWPHQWV LQ WKH FHQWUHV ,Q WHUPV RI GDWD SURWHFWLRQ WKH SURJUDPPH IXOO\ FRPSOLHV ZLWK WKH $XVWULDQ GDWD SURWHFWLRQ DFW '6* YDOLG VLQFH $FFHVV WR WKH GDWD EDVH LQ WKH FHQWUHV LV UHVWULFWHG WR

WKH GHYHORSPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP 7KH UHTXLUHG KDUGZDUH LV SURYLGHG E\ WKH ORFDO

HIV Patient Management System: 'HVLJQHG DV D FOLHQW VHUYHU DSSOLFDWLRQ WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP VWRUHV LWV GDWD LQ D SHUVLVWHQW 64/ GDWDEDVH 7KH VRIWZDUH LV EDVHG RQ WKH PRGHO GULYHQ DUFKLWHFWXUH SDUDGLJP DQG KDV EHHQ LPSOHPHQWHG ZLWK 0LFURVRIW 1(7 WHFKQRORJ\ 7KH FRPSDQ\ ', +HLQ] $SSR\HU QRZ FDOOHG QHWZRUN YLWD ZDV HQWUXVWHG ZLWK

$ VSHFLDO VRIWZDUH WKH ³+,9 3DWLHQW 0DQDJHPHQW 6\VWHP +,3 ´ LV XVHG LQ DOO FHQWUHV DQG KDV UHSODFHG WKH SUHYLRXV +,9 GDWD EDVH LQ 7KH LQSXW RI GDWD LV ZDV GRQH SHULSKHUDOO\ LQ WKH +,9 WUHDWPHQW FHQWUHV ZKLFK FRQVLVWHQWO\ XVH WKH GDWD EDVH IRU FOLQLFDO FDUH 7KH LQSXW RI ODERUDWRU\ ¿QGLQJV LV PRVWO\ GRQH HOHFWURQLFDOO\ $SDUW IURP QXUVHV DQG GRFWRUV DGGLWLRQDO SURIHVVLRQDO JURXSV DUH LQYROYHG LQ GDWD HQWU\ LQ VRPH FHQWUHV VRFLDO ZRUNHUV SV\FKRORJLVWV %HIRUH GDWD FDQ EH PHUJHG WKH FRKRUW SDUWLFLSDQWV DUH PDGH DQRQ\PRXV 7KHUHIRUH LW LV YHU\ GLI¿FXOW WR LGHQWLI\ FRKRUW SDUWLFLSDQWV ZKR DUH ZHUH WUHDWHG LQ PRUH WKDQ MXVW RQH WUHDWPHQW FHQWUH 7KLV FDQQRW EH GRQH E\ WKH XVH RI SHUVRQDO GDWD VXFK DV LQLWLDOV ELUWKGD\ RU SRVWDO FRGH EXW ZLWK +,9 VSHFL¿F GDWD GDWH RI WKH +,9 WHVW &' FHOO FRXQWV HWF

Aims of this cohort study are: 2SWLPL]DWLRQ RI SDWLHQW PDQDJHPHQW 4XDOLW\ PDQDJHPHQW 'RFXPHQWDWLRQ RI WKH HSLGHPLRORJ\ RI WKH +,9 LQIHFWLRQ )DFLOLWDWLRQ RI UHVHDUFK SURMHFWV

$W WKH HQG RI WKH \HDU UHSUHVHQWDWLYHV RI $XVWULDQ +,9 WUHDWPHQW FHQWUHV $.+ 9LHQQD 2WWR :DJQHU +RVSLWDO 9LHQQD $.+ /LQ] /.+ ,QQVEUXFN DQG /.+ *UD] :HVW KDYH IRXQGHG WKH “Austrian HIV Cohort Study (AHIVCOS)” ,Q WZR PRUH FHQWUHV /.+ 6DO]EXUJ DQG /.+ .ODJHQIXUW MRLQHG WKH $+,9&26 7KH UHVSRQVLELOLW\ IRU WKH PHGLFDO DQG VFLHQWL¿F FRRUGLQDWLRQ OLHV ZLWK 5REHUW =DQJHUOH

1. INTRODUCTION

&$6&$'( DQG &2+(5( KDV EHHQ DQG ZLOO EH JUHDWO\ IDFLOLWDWHG

7KH GHYHORSPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP LQFRUSRUDWHG WKH LQWHUQDWLRQDO VWDQGDUG IRUPDW WKH +,9 &RKRUWV 'DWD ([FKDQJH 3URWRFRO +,&'(3 VR WKDW GDWD PHUJLQJ ZLWK QHWZRUNV RI FRKRUWV OLNH $57 &&

WDVNV RI TXDOLW\ PDQDJHPHQW DQG VWDQGDUGL]DWLRQ RI FDUH FDQ EH PDQDJHG PRUH HI¿FLHQWO\ E\ XVLQJ +,3 7KH HVWDEOLVKPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP LV D ELJ DGYDQFH LQ WKH PDQDJHPHQW RI SDWLHQWV ZLWK +,9 $,'6 ³*RRG &KURQLF 'LVHDVH 3UDFWLFH´

ORFDO ,7 V\VWHPV LV OHJLWLPL]HG )RU ,7 GHSDUWPHQWV +,3 DV DQ ³LVRODWHG DSSOLFDWLRQ´ LV VHHQ DV DQ DGGLWLRQDO OLDELOLW\ 2Q WKH RWKHU KDQG KRVSLWDOV KDYH DOVR DQ LQWHUHVW LQ WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP EHFDXVH

RI WKH +,9 PHGLFDWLRQ 7KH ,7 GHSDUWPHQWV LQ WKH KRVSLWDOV KDYH WR SURYLGH WKH ,7 KDUGZDUH DV ZHOO DV WKH VHUYLFH GDWD VHFXULW\ %HFDXVH RI WKH VXSSRUW RI %0* DQG $*(6 WKH FROODERUDWLRQ EHWZHHQ WKH $XVWULDQ +,9 &RKRUW 6WXG\ DQG WKH KRVSLWDOV HVSHFLDOO\ ZLWK WKH ORFDO ,7 GHSDUWPHQWV H J LQWHUIDFHV EHWZHHQ +,3 DQG

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

2. ORGANIZATION AND DEVELOPMENT OF THE AUSTRIAN HIV COHORT STUDY

Tyrol

Innsbruck

$JH JHQGHU PRGH RI WUDQVPLVVLRQ RI +,9 6HURFRQYHUVLRQ LOOQHVV $,'6 GLDJQRVHV DOO FDVHV RI GHDWK

Merger of data: 2QO\ LQGLUHFWO\ SHUVRQDO GDWD DFFRUGLQJ WR WKH GDWD SURWHFWLRQ DFW H J QR GDWH RI ELUWK QR LQLWLDOV QR SRVWDO FRGH HWF

6HPLDQQXDO

5HVLVWDQFHV WR DQWLUHWURYLUDO GUXJV $QWLUHWURYLUDO WKHUDSLHV SDVW DQG SUHVHQW

&R PRUELGLWLHV FDUGLRYDVFXODU GLVHDVHV GLDEHWHV PDOLJQDQF\

&R LQIHFWLRQV V\SKLOLV KHSDWLWLV % KHSDWLWLV & WXEHUFXORVLV

&' O\PSKRF\WH FRXQW +,9 51$ KDHPRJORELQ

)LUVW FRQWDFW ZLWK WKH +,9 FHQWUH

Minimal dataset:

H[DPLQHG DQG ¿QGLQJV UHVXOWV GRFXPHQWHG DW UHJXODU YLVLWV WKHUHIRUH QR DGGLWLRQDO FRVWV ZLOO DULVH

Frequency of the monitoring (“Follow-up”): 0RVW SDWLHQWV LQ +,9 FDUH LQ $XVWULD ZLOO EH FOLQLFDOO\ UHYLHZHG HYHU\ PRQWKV &RKRUW SDUWLFLSDQWV ZLOO EH

3DWLHQW ZLWKKROGV FRQVHQW

Exclusion criteria: 3K\VLFLDQ¶V GHFLVLRQ

Inclusion criteria: 3URRI RI WKH +,9 LQIHFWLRQ

$*(6 E\ RUGHU RI WKH )HGHUDO 0LQLVWU\ RI +HDOWK WKH SDUWQHUV LQ WKH SKDUPDFHXWLFDO LQGXVWU\ DOO FRPSDQLHV SURYLGLQJ +,9 GUXJV DQG WKH SDUWLFLSDWLQJ FOLQLFV URXWLQH PDLQWHQDQFH FRQWUDFWV

Graz

Burgenland

$OWKRXJK QRW EHLQJ D UHTXLUHPHQW GXH WR WKH DERYH PHQWLRQHG OHJDO VLWXDWLRQ WKH $XVWULDQ +,9 &RKRUW 6WXG\ KDV JDLQHG DSSURYDO RI WKH HWKLFDO FRPPLWWHHV IRU WKH PDMRULW\ RI WKH +,9 WUHDWPHQW FHQWUHV WKH UHPDLQLQJ ZLOO IROORZ LQ WKH FRPLQJ PRQWKV RI :LWK WKLV WKH $XVWULDQ +,9 &RKRUW 6WXG\ KDV EHHQ UHDG\ WR MRLQ WKH LQWHUQDWLRQDO QHWZRUN RI FRKRUWV OLNH $57 && &$6&$'( DQG &2+(5(

/DVW QHJDWLYH DQG ¿UVW SRVLWLYH +,9 WHVW

Klagenfurt

Styria

ZHOO DV WKH SURYLVLRQ RI HSLGHPLRORJLFDO UHSRUWV H J ³&RKRUW UHSRUW´ DUH VHFXUHG ZLWK WKH SXEOLF VHFWRU

Carinthia

Salzburg

Lower Austria

Vienna

7KH )HGHUDO $FW &RQFHUQLQJ WKH 3URWHFWLRQ RI 3HUVRQDO 'DWD 'DWHQVFKXW]JHVHW] '6* 6HFW KDV DFNQRZOHGJHG VSHFLDO SXUSRVHV RI GDWD UHJDUGLQJ VFLHQWL¿F UHVHDUFK DQG VWDWLVWLFV ³)RU WKH SXUSRVH RI VFLHQWL¿F RU VWDWLVWLFDO UHVHDUFK SURMHFWV ZKRVH JRDO LV QRW WR REWDLQ UHVXOWV LQ D IRUP UHODWLQJ WR VSHFL¿F GDWD VXEMHFWV >%HWURIIHQH@ WKH FRQWUROOHU >$XIWUDJJHEHU@ VKDOO KDYH WKH ULJKW WR XVH DOO GDWD WKDW « DUH RQO\ LQGLUHFWO\ SHUVRQDO IRU WKH FRQWUROOHU ´

4. DEFINITION OF THE COHORT PARTICIPANTS

7KH $XVWULDQ +,9 &RKRUW 6WXG\ $+,9&26 ZLOO EH ¿QDQFHG XQWLO 6HSWHPEHU VHH DOVR SURMHFW SODQ ± 7KH PDLQWHQDQFH DQG WKH IXWXUH GHYHORSPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP ³+,3´ DV

3. FINANCING

Vorarlberg

Upper Austria

Linz

&(175(6 2) 7+( $8675,$1 +,9 &2+257 678'<

MENT W-UP HORT ANTS

1742

1843

1951

2047

2112

2296*

01.01.2004

01.01.2005

01.01.2006

01.01.2007

01.01.2008

01.01.2009 01.01.2010

1800 2008

1287

1154

1030

897

786

681

AKH Vienna

799 835

745

707

658

621

595

463

Linz

Since 1.7.2009 0 3 1 1 2 2 3 1 8 21

Before 1.1.2005 8 268 18 32 172 88 10 11 233 840 Total 8 305 27 45 191 124 22 16 346 1084

4192 4553

5329

5018

4691

4351

4037

3652

Total

Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna Total

102 118

Klagenfurt

Death 1.1.2009 to 1.1.2005 to 30.06.2009 31.12.2008 0 0 3 31 1 7 1 11 1 16 1 33 0 9 0 4 9 96 16 207

409 446

344

305

275

241

209

187

Graz

Total 132 495 197 387 385 419 56 98 1300 3469

870 910

841

805

777

749

705

669

Innsbruck

Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna Total

212 236

Salzburg

Last monitoring with CD4 cell count by residence Missing or Since 1.1.2009 to 1.1.2005 to before 1.7.2009 30.06.2009 31.12.2008 1.1.2005 108 5 12 7 385 14 45 51 160 2 28 7 281 11 48 47 351 6 17 11 302 20 46 51 29 3 5 19 23 5 28 42 776 74 231 219 2415 140 460 454

*Data transfer was too late for incorporating into analyses.

1652

01.01.2003

OWS Vienna

Cumulative number of all cohort participants

6R IDU +,9 LQIHFWHG SDWLHQWV SURYLGLQJ SHUVRQ \HDUV RI IROORZ XS KDYH EHHQ UHFUXLWHG LQWR WKH FRKRUW VWXG\ :H DVVXPH WKDW WKHUH ZHUH PRUH WKDQ GHDWKV EXW GDWD HQWU\ IURP SDWLHQWV ZLWK ORVV RI IROORZ XS RU ODVW FRQWDFW D ORQJ WLPH DJR LV LQFRPSOHWH 0RVW FHQWUHV GR QRW KDYH HQRXJK UHVRXUFHV WR HQWHU GDWD UHWURVSHFWLYHO\

$ ORQJ VWDQGLQJ DLP RI WKH $XVWULDQ +,9 FRKRUW VWXG\ LV D ZLGH YROXQWDU\ DQG DQRQ\PRXV FDSWXUH RI +,9 LQIHFWHG SDWLHQWV LQ $XVWULD

5. RECRUITMENT AND FOLLOW-UP OF COHORT PARTICIPANTS

l ro Ty

1.1.2005 to 31.12.2008

Since 1.7.2009

1.1.2009 to 30.06.2009

a a d g ia ng tri tri ur an th si us us in nl zb is l r e A A a M rg Sa C er er w Bu pp Lo U

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1.1.2009 to 30.06.2009

ia yr St

na en Vi

l ro Ty

g er lb r ra Vo 1.1.2005 to 31.12.2008

ia yr St

l ta To

Before 1.1.2005

na en i V

l ta To

Missing or before 1.1.2005

g er lb ar r Vo

Deaths in different periods (deceased cohort participants)

Since 1.7.2009

ia rg ria ria nd ng th st st si la bu is lz rin en Au Au a a M g r r r S C e e w Bu pp Lo U

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Last monitoring with CD4 cell count (living cohort participants)

3HUVRQV ZLWK UHVLGHQF\ DEURDG ZHUH H[FOXGHG IURP WKLV DQDO\VLV

5,6. )$&7256 )25 12 )2//2: 83 ,1 7+( /$67 0217+6

Univariate regression OR (95% CI) p-value

Frequencies N = 979 / 3371 (29,04%)

<0,001

(32,90%) (25,18%)

555 / 1687 424 / 1684

1,46 1,25 â&#x20AC;&#x201C; 1,69 1

0,009

1,34 1,08 â&#x20AC;&#x201C; 1,68 1

0,010

Model 1 (N= 3371) Multivariate regression* OR (95% CI) p-value

All centres

/ 1161 / 567 / 240 / 1403

1,25 1,05 â&#x20AC;&#x201C; 1,47 1

(30,35%) (25,93%)

720 / 2372 259 / 999

Variable Demographic characteristics $JH <43 years t 43 years *HQGHU Male Female

0,367 0,003 <0,001

0,89 0,70 â&#x20AC;&#x201C;1,14 1,47 1,14 â&#x20AC;&#x201C;1,89 2,32 1,64 â&#x20AC;&#x201C;3,30 1

(27,82%) (33,51%) (44,17%) (25,66%)

323 190 106 360

1,12 0,94 â&#x20AC;&#x201C; 1,33 1,46 1,18 â&#x20AC;&#x201C; 1,80 2,29 1,73 â&#x20AC;&#x201C; 3,04 1

0,218 <0,001 <0,001

<0,001

0,36 0,30 â&#x20AC;&#x201C;0,43 1

(21,97%) (40,31%)

455 / 2071 524 / 1300

0,42 0,36 â&#x20AC;&#x201C; 0,49 1

<0,001

2,46 1,88 â&#x20AC;&#x201C;3,21 1

<0,001

(41,71%) (27,23%)

176 / 422 803 / 2949

1,91 1,55 â&#x20AC;&#x201C; 2,36 1

<0,001 0,42 0,34 â&#x20AC;&#x201C; 0,51 1 (16,95%) (32,93%) 139 / 820 840 / 2551

0,164 0,041 0,82 0,62 â&#x20AC;&#x201C; 1,08 0,80 0,64 â&#x20AC;&#x201C;0,99 1 <0,001 <0,001 0,43 0,34 â&#x20AC;&#x201C; 0,55 0,48 0,40 â&#x20AC;&#x201C; 0,58 1 / 93 (100,00%) / 505 (18,02%) / 1017 (19,76%) / 1756 (33,83%) 93 91 201 594

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No &' QDGLU Missing 50 cells/Îźl 50-199 cells/Îźl t 200 cells/Îźl ART $57 XVH HYHU

<0,001 0,19 0,15 â&#x20AC;&#x201C;0,23 1 <0,001 0,15 0,13 â&#x20AC;&#x201C;0,18 1 (19,52%) (61,52%) 509 / 2607 470 / 764 Yes No

AKH Vienna 457 495 568 648 690 759 845 961

Linz 240 251 273 290 328 358 383 401

Salzburg 140 167

Innsbruck 368 384 411 429 447 469 483 517

2 1 0 768 0 6 961

Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

Lower Austria

154

Carinthia

Salzburg

Burgenland

AKH Vienna 21

Upper Austria

ahl

401

369

Linz 0

167

122

Salzburg 0

517

102

349

Innsbruck 0

HIV-centre

Number of â&#x20AC;&#x153;currentlyâ&#x20AC;? seen patients by residence

* Cohort participants with a CD4 cell count within the previous 6 months ** Data transfer was too late for incorporating into analyses.

01.01.2003 01.01.2004 01.01.2005 01.01.2006 01.01.2007 01.01.2008 01.01.2009 01.01.2010

OWS Vienna 577 617 665 706 769 783 829**

287

268

Graz 7

Graz 129 147 161 188 204 223 263 287

Klagenfurt 0

Klagenfurt 90 97

Number of â&#x20AC;&#x153;currentlyâ&#x20AC;? seen cohort participants at different points in time*

2430

785

102

353

281

160

386

173

108

Total

Total 1771 1894 2078 2261 2438 2592 2204 2430

06 04 02 04 05 03 03 05 06 07 07 08 08 09 09 10 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 7. 1. 1. 7. 1. 7. 1. 7. 1. 7. 7. 1. 7. 7. 1. 1. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . . . . . . . . . . . . . . . . 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01

3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0

%HFDXVH RI WKH KLJK QXPEHU RI SDWLHQWV ZLWK LQFRPSOHWH IROORZ XS PRVW RI WKH DQDO\VHV ZHUH GRQH XVLQJ RQO\ WKH GDWD RI SDWLHQWV ZLWK &' FHOO FRXQW ZLWKLQ WKH SUHYLRXV PRQWKV 6XFK D VHOHFWLRQ LQĂ&#x20AC;XHQFHV WKH UHVXOWV RI VRPH DQDO\VHV H J ULVN IRU +,9 51$ KLJKHU WKDQ FRSLHV PO

&216758&7,21 2) $ Âł&855(17 &2+257Â´

Currently seen cohort participants * adjusted for the variables: age

EMOGRAPHIC ACTERISTICS THE COHORT ARTICIPANTS

112

120

238

122

199

241

569

1685

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

2430

785

102

353

281

160

386

173

108

Total

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male

Female

Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing

Federal state

Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing

Federal state

Female

*(1'(5 $021* +(7(526(;8$//< $&48,5(' +,9 ,1)(&7,21

745

216

148

Female

Carinthia

Male

Gender

Burgenland

nzahl

RI WKH FRKRUW SDUWLFLSDQWV DUH IHPDOH 7KH UDWH LV KLJKHVW LQ 8SSHU $XVWULD DQG 9RUDUOEHUJ ,Q WKH VXEJURXS RI WKH KHWHURVH[XDOO\ LQIHFWHG WKH UDWH RI WKH ZRPHQ LV ,W LV KLJKHVW LQ 9LHQQD 8SSHU $XVWULD DQG 9RUDUOEHUJ

*(1'(5 2) 7+( &855(17 &2+257 3$57,&,3$176

39,3

40,0 40,3

40,8 40,7

41,0 41,1

41,4 41,5

41,8 42,0

42,5 42,5

42,9 43,0

43,4

5 2 3 4 4 3 5 6 7 6 8 7 8 9 0 9 00 00 00 200 200 200 200 200 200 200 200 200 200 200 200 201 . . .2 1.2 7.2 . . . . . . . . . . . 1 7 7 7 7 1 1 1 1 7 7 7 1 1 .0 1.0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 .0 1.0 .0 1.0 1.0 0 01 0 0 01 0 01 0 0 01 0 01 0 0 01 0

36 35

44 43 42 41 40 39 38 37

100

125

150

175

200

Age

Current cohort â&#x20AC;&#x201C; all patients

For. Miss. c.

7KH DYHUDJH DJH RI WKH SDWLHQWV LV \HDUV DQG LW LV YHU\ VLPLODU DFURVV WKH IHGHUDO VWDWHV 7KH PHGLDQ LV \HDUV RI WKH FRKRUW SDUWLFLSDQWV DUH ROGHU WKDQ \HDUV DUH ROGHU WKDQ \HDUV

Median age (years)

$*( 2) 7+( &855(17 &2+257 3$57,&,3$176

Number of persons

6. DEMOGRAPHIC CHARACTERISTICS OF THE COHORT PARTICIPANTS

Age (years)

Tyrol

Upper Austria

Vienna

Current cohort â&#x20AC;&#x201C; injecting drug use

All modes of transmission

Others

104

106

350

857

Carinthia

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

Burgenland

MSM

384

147

IDU

Blood products

1052

268

141

134

209

Heterosexual

Mode of transmission

Vertical

Unknown

2430

785

102

353

281

160

386

173

108

Total

SDUWLFLSDQWV ZKR KDYH UHFHLYHG FRDJXODWLRQ FRPSRXQGV RU EORRG WUDQVIXVLRQV ,Q WKH FXUUHQW FRKRUW RI WKH SDUWLFLSDQWV KDYH EHHQ LQIHFWHG WKURXJK KHWHURVH[XDO FRQWDFWV WKURXJK KRPRVH[XDO FRQWDFWV DQG WKURXJK WKH LQMHFWLRQ RI GUXJV

%HORZ WKH DEEUHYLDWLRQ 060 LV XVHG IRU Â³0HQ ZKR KDYH VH[ ZLWK PHQÂ´ ,'8 PHDQV Â³,QMHFWLQJ 'UXJ 8VHÂ´ 7KH FDWHJRU\ ,'8 DOVR LQFOXGHV PHQ ZKR DUH ERWK 060 DQG ,'8 7KH FDWHJRU\ Â³EORRG SURGXFWVÂ´ LQFOXGHV FRKRUW

6.4.1

02'( 2) 75$160,66,21 2) 7+( +,9 ,1)(&7,21

Age (years)

Missing

MSM

ria ria st st Au Au r r e we pp Lo U

ia th

IDU

r bu lz a S

Mother-to-child-transmission

in ar

r Ty

Blood products

yr St

r ra Vo

r Fo

gn ei

na en Vi

Heterosexual

er lb

Mode of transmission (current cohort)

g in iss

Vertical

es t ri un o c

Unknown

l ta To

Burgenland Lower Austria Upper Austria Styria Tyrol Vorarlberg Vienna Missing residency Total

Living participants <18 years >18 years 1 1 1 0 5 3 2 3 0 5 4 0 3 2 4 0 20 14

0 0 1 0 4 1 0 0 6

Deceased participants

2 1 9 5 9 5 5 4 40

Total

KHUH DUH UHODWHG WR SDWLHQWV ZKR KDYH DOVR EHHQ LQ FDUH E\ WKH DGXOW +,9 WUHDWPHQW FHQWUHV 2EYLRXVO\ WKHVH GDWD DUH LQFRPSOHWH

1RZDGD\V PRWKHU WR FKLOG WUDQVPLVVLRQ LV WKH RQO\ URXWH RI +,9 WUDQVPLVVLRQ DPRQJVW FKLOGUHQ $OO +,9 LQIHFWHG FKLOGUHQ LQ $XVWULD DUH IROORZHG LQ SDHGLDWULF +,9 WUHDWPHQW FHQWUHV WKHUHIRUH WKH GDWD SUHVHQWHG

6.4.2

nd la en g r Bu

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

5HFHQWO\ DW OHDVW WZR WUDQVPLVVLRQV RI PRWKHU WR FKLOG LQ $XVWULD KDYH EHHQ OLQNHG WR FRXQVHOOLQJ ZLWK +,9 GHQLDOLVWV

,Q -DQXDU\ URXWLQH +,9 WHVWLQJ ZDV LQWURGXFHG LQ $XVWULD 7KH +,9 WHVW LV SDUW RI WKH PRWKHU FKLOG ERRNOHW 0XWWHU .LQG 3DVV ,Q RUGHU WR EH HOLJLEOH IRU FKLOGFDUH DOORZDQFH .LQGHUEHWUHXXQJVJHOG \RX PXVW KDYH WKH Â¿UVW WHQ H[DPLQDWLRQV VWLSXODWHG LQ WKH PRWKHU FKLOG ERRNOHW GRQH FRUUHFWO\ DQG REWDLQ SURRI RI LW

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

k g ch Country of birth - all patients

Nationality - Heterosexual

Nationality - IDU

Nationality - MSM

Nationality - all patients

1$7,21$/,7< $1' &28175< 2) %,57+ /,9,1* 3$57,&,3$176

,Q WKH IUDPHZRUN RI VWDWXWRU\ KHDOWK LQVXUDQFH DOO JDLQIXOO\ DFWLYH SHUVRQV PXVW EHFRPH LQVXUHG $SSUR[LPDWHO\ RI WKH $XVWULDQ SRSXODWLRQ DUH SURWHFWHG E\ VWDWXWRU\ KHDOWK LQVXUDQFH 'HSHQGLQJ RQ WKH W\SH RI HPSOR\PHQW WKHUH DUH GLIIHUHQW NLQGV RI PDQGDWRU\ KHDOWK LQVXUDQFH H J %9$ IRU FLYLO VHUYDQWV 69$ IRU EXVLQHVVPHQ DQG EXVLQHVVZRPHQ DQG *.. IRU PRVW HPSOR\HHV

+($/7+ ,1685$1&(

3529,'(56 2) +($/7+ &$5(

STAGE O DISEASE

386

160

281

353

102

785

2430

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

216

316

223

215

224

221

227

178

201

208

248

n la en rg

30%

40%

50%

60%

70%

80%

90%

727

266

113

bu lz Sa

399

175

ia yr St

l ro

197

e rlb

ra Vo

254

en Vi

re Fo

na n ig

un co

tri

B Non-AIDS defining conditions B1 B2 B3

Classification according to C DC

A Asymptomatic A1 A2 A3

ria ria st st Au Au r r e pe w Lo Up

144

Total

ia th in

Missing

r Ca

Foreign countries

Vienna

100%

5% >500

Styria 24

Salzburg Tyrol

9 15

Lower Austria

Carinthia Upper Austria

Burgenland

Vorarlberg

10%

2204

489

1099

1093

1346

908

821

1109

690

813

Maximum 738

10%

Minimum 9

20%

50-199 200-349 350-500

196

205

230

197

175

179

223

145

191

194

258

Median 253

CD4 count 1 Â&#x2022; 500/Îźl 2 200-499/Îźl 3 < 200/Îźl

ng si is

600

157

100

132

ta To

2430

785

102

353

281

160

386

173

108

Total

C AIDS C1 C2 C3

7KH FODVVLÂżFDWLRQ RI WKH +,9 LQIHFWLRQ DFFRUGLQJ WR &'& SXWV SDWLHQWV LQ RQH RI WKUHH FOLQLFDO FDWHJRULHV $ % & DQG RQH RI WKUHH &' FHOO FRXQW FDWHJRULHV

&/$66,),&$7,21 2) 7+( &855(17 &2+257 $&&25',1* 72 &'&

15%

20%

25%

30%

35%

40%

45%

<50

173

50%

108

Carinthia

Lower Austria

Mean 265

Current cohort CD4 nadir

Number 28

Burgenland

CD4 nadir (current cohort)

7KH PHGLDQ RI WKH ORZHVW &' FHOO FRXQW HYHU PHDVXUHG Âł&' QDGLUÂ´ LQ WKH FXUUHQW FRKRUW LV Â&#x2014;O

/2:(67 (9(5 0($685(' &' &(// &2817 &855(17 &2+257

7. STAGE OF HIV DISEASE

“ELITENTROLLERS” D “VIREMIANTROLLERS”

CD4 > 500 cells/Îźl and HIV RNA < 400 copies/ml

CD4 > 500 cells/Îźl and HIV RNA < 1000 copies/ml

CD4 > 500 cells/Îźl and HIV RNA Â&#x201D; 50 copies/ml

3,5%

2,7%

1,1%

243 17,4%

4,9%

CD4 > 500 cells/Îźl

HIV RNA < 1000 copies/ml

3,5%

142 10,1%

HIV RNA < 400 copies/ml

1,5%

HIV RNA < 5000 copies/ml

533 38,1%

1,2%

1,1%

0,8%

5,2%

2,7%

1,8%

1,5%

1,1%

75 10,3%

N = 728

N = 1400

HIV RNA Â&#x201D; 50 copies/ml

All patients

HIV-infected without ART use

HIV-infected for 6 to 10 years

HIV-infected up to 5 years

1,0%

0,7%

0,3%

2,0%

1,7%

1,4%

1,1%

0,5%

3,5%

N = 1157

HIV-infected for over 10 years

0HGLDQ WLPH IURP +,9 LQIHFWLRQ WR GHDWK LQ XQWUHDWHG SDWLHQWV LV HVWLPDWHG WR EH DSSUR[LPDWHO\ \HDUV +RZHYHU WKHUH LV FRQVLGHUDEOH YDULDWLRQ LQ VXUYLYDO WLPH EHWZHHQ SDWLHQWV $ VPDOO QXPEHU RI SDWLHQWV UHPDLQ DV\PSWRPDWLF IRU PDQ\ \HDUV DQG PDLQWDLQ KLJK &' FHOO FRXQWV RU ORZ SODVPD +,9 51$ OHYHOV RU ERWK ZLWKRXW DQWLUHWURYLUDO WKHUDS\ 3DWLHQWV DEOH WR PDLQWDLQ KLJK &' FRXQWV KDYH EHHQ FDOOHG ÂłORQJ WHUP QRQ SURJUHVVRUVÂ´ ZKLOVW WKRVH ZLWK ORZ YLUDO ORDGV KDYH EHHQ FDOOHG Âł+,9 FRQWUROOHUVÂ´ RU ÂłHOLWH FRQWUROOHUVÂ´ 9LUHPLF FRQWUROOHUV KDYH ORZ EXW UHDGLO\ PHDVXUDEOH YLUXV ORDGV (OLWH FRQWUROOHUV VXSSUHVV +,9 WR H[WUHPHO\ ORZ OHYHOV PHDVXUDEOH RQO\ E\ VHQVLWLYH ODERUDWRU\ WHFKQLTXHV

8. â&#x20AC;&#x153;ELITE-CONTROLLERSâ&#x20AC;? AND â&#x20AC;&#x153;VIREMIA-CONTROLLERSâ&#x20AC;?

Lower Austria

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

Active Syphilis: prevalence

Carinthia

1969

593

312

222

132

331

138

No infection 23

349

156

Status post Syphilis 3

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

MSM 3 3 5 8 25 71 45 52 32 244

Men (not MSM) 0 2 1 3 5 16 8 4 6 45 Women 0 2 1 0 2 6 2 0 2 15 Total 3 7 7 11 32 93 55 56 40 304

7KH IROORZLQJ DQDO\VLV LQFOXGHV DOO DFWLYH FDVHV RI V\SKLOLV E\ \HDU RI GLDJQRVLV QHZ V\SKLOLV GLDJQRVHV 7KHUHIRUH UHFHQW V\SKLOLV FDVHV DQG LQIHFWLRQV RI XQNQRZQ GXUDWLRQ DUH LQFOXGHG

9.1.2

Missing 2

Burgenland

9.1.1 Missing values and status post syphilis diagnoses (current cohort)

6\SKLOLV FDQ SHUVLVW IRU VHYHUDO \HDUV ZKHQ LW LV QRW WUHDWHG DQG UHLQIHFWLRQ ZLWK V\SKLOLV LV SRVVLEOH EHFDXVH WKHUH LV QR SURWHFWLYH LPPXQLW\

6<3+,/,6

9. CO-INFECTIONS

2003

2004 MSM

2005

2006

2007

Men (not MSM)

New â&#x20AC;&#x153;recentâ&#x20AC;? syphilis infections: incidence

100

120

2008

2009 Women

2003

2004 MSM

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

2005

MSM 1 0 3 2 6 26 27 33 19 117

Women 0 0 0 0 0 2 2 0 1 5

2007 Men (not MSM)

2006

Men (not MSM) 0 1 0 1 0 4 3 0 3 12

2008

Women

2009

Total 1 1 3 3 6 32 32 33 23 134

7KLV DQDO\VLV RQO\ LQFOXGHV QHZ ÂłUHFHQWÂ´ V\SKLOLV LQIHFWLRQV GHÂżQHG DV IROORZV SDWLHQWV ZLWK D IRUPHU V\SKLOLV UHVXOW WKDW ZDV HLWKHU QHJDWLYH RU D VWDWXV SRVW WUHDWPHQW DQG ZKR QRZ SUHVHQWHG ZLWK DFWLYH V\SKLOLV QHZ ÂłUHFHQWÂ´ V\SKLOLV LQIHFWLRQV

9.1.3

Cases per 1000 person-years Cases per 1000 person-years

769

1645

Vorarlberg

Vienna

Foreign countries

Missing

Total

652

252

118

127

119

Latent infection 0

Tuberculosis 0

2430

785

102

353

281

160

386

173

108

Total

550

Upper Austria

Salzburg

Styria

Tyrol

Vorarlberg

Vienna

Foreign countries

Missing

Total

Lower Austria

1834

248

231

144

290

144

Carinthia

No infection

Missing

Burgenland

zahl

ZHUH FODVVLÂ¿HG DV +&9 QHJDWLYH

110

Ab positive, HCV RNA neg. (spontaneous)

Hepatitis C

Ab positive, HCV RNA neg. (therapy)

361

120

Chronic HCV

2430

785

102

353

281

160

386

173

108

Total

+&9 FR LQIHFWLRQ ZDV GHÂ¿QHG E\ D SRVLWLYH UHVXOW RQ D TXDOLWDWLYH RU TXDQWLWDWLYH 51$ WHVW UHVXOW :H DVVXPHG WKDW SDWLHQWV ZLWK D SRVLWLYH +&9 DQWLERG\ WHVW EXW ZLWKRXW DQ DYDLODEOH +&9 51$ WHVW ZHUH DOVR FR LQIHFWHG ZLWK +&9 +RZHYHU SDWLHQWV ZLWK D SRVLWLYH +&9 DQWLERG\ WHVW DQG D QHJDWLYH UHVXOW RQ DQ +&9 51$ WHVW

+(3$7,7,6 & &855(17 &2+257

Tyrol

Upper Austria

229

Lower Austria

256

165

Carinthia

Styria

102

Burgenland

Salzburg

Missing 28

No infection 0

18 2 1 12 1 0 125 1 5 183

Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

661

186

106

142

No infection 8

954

310

141

124

173

Antibody positive 10

Hepatitis B No antibodies despite vaccination 0

517

132

146

Antibody positive (vaccination) 5

Chronic HBV 0

2430

785

102

353

281

160

386

173

108

Total

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1.7.2004

1.7.2006 Lamivudin only Tenofovir + Lamivudin ART without HBV-medication

1.7.2005

1.7.2008

1.7.2009 Tenofovir only Tenofovir + Emtricitabin Neither ART nor HBV-therapy

1.7.2007

157, EDFNERQHV LQ F$57 FRPELQDWLRQV IRU +%9 +,9 FR LQIHFWHG SDWLHQWV 0RVW RI WKH +%9 +,9 FR LQIHFWHG SDWLHQWV LQ FDUH DW RQH RI WKH $XVWULDQ +,9 WUHDWPHQW FHQWUHV UHFHLYHG DQ 157, EDFNERQH WR KHOS FRQWURO WKH +%9 LQIHFWLRQ

Therapy for hepatitis B &XUUHQW JXLGHOLQHV UHFRPPHQG WKH XVH RI WHQRIRYLU DQG HPWULFLWDELQH RU WHQRIRYLU DQG ODPLYXGLQH DV WKH

Burgenland

Missing 5

Carinthia

nzahl

&KURQLF +%9 ZDV GHÂ¿QHG E\ D SRVLWLYH UHVXOW RQ D KHSDWLWLV % VXUIDFH DQWLJHQ +%V$J WHVW RU E\ D SRVLWLYH +%9 '1$ WHVW UHVXOW

7XEHUFXORVLV LV LQFRPSOHWHO\ UHFRUGHG LQ WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP

Tuberculosis

+(3$7,7,6 % &855(17 &2+257

78%(5&8/26,6 &855(17 &2+257

$JH \HDUV r V G

)HGHUDO VWDWH Upper Austria Styria Tyrol Others/missing/foreign countries Vienna *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero &RLQIHFWLRQ ZLWK +%9 +&9 $,'6 &' QDGLU FHOOV Â&#x2014;O r V G

&XUUHQW &' FHOOV Â&#x2014;O r V G

/DVW +,9 51$ log10 copies/ml (Â± s.d.) <400 copies/ml d50 copies/ml 6WDJH RI GLVHDVH Liver cirrhosis Current renal insufficiency (stage 3, 4, 5) Last bilirubin (mg/dl Â± s.d.) Last PT (% Â± s.d.) Last patelet count (G/l Â± s.d.) +,9 WKHUDS\ Currently on therapy +HSDWLWLV WKHUDS\ Currently on therapy Previous treatment

87,2%

88,5%

69 -

18 65

319 4,9% 18,3%

88,4%

37 10,2% 21 5,8% 0,9 r 2,1 93 r 14,3 195 r 80,4

4 5,1% 5 6,4% 1,1 r 2,8 94 r 14,1 204 r 70,9

1,9 r 1,1 301 83,4% 270 74,8%

63,2% 36,8%

2,2 r 1,3 57 73,1% 53 67,9%

228 133

22,2% 6,6% 19,9% 18,0% 33,2%

21 5,8% 255 70,6% 29 8,0% 56 15,5% 13 3,6% 158 43,8% 168 r 150,8 501 r 307,4

74,4% 25,6%

58 20

80 24 72 65 120

26 33,3% 23 29,5% 9 11,5% 20 25,6% 13 16,7% 29 37,2% 181 r 158,1 414 r 246,6

12,8% 16,7% 14,1% 16,7% 39,7%

n= 361 43,1 r 9,4

n= 78 39,0 r 9,7

10 13 11 13 31

Chronic hepatitis C

Chronic hepatitis B

ZKR KDYH EHHQ FOHDUHG IURP +&9 KDYH UHFHLYHG DQWL +&9 WKHUDS\ 7KH SDWLHQWV ZLWK D VXVWDLQHG YLURORJLFDO UHVSRQVH DUH DFFRPSDQLHG E\ SDWLHQWV ZKR IDLOHG YLURORJLFDOO\ WKXV UHYHDOLQJ D VXFFHVV UDWH RI SDWLHQWV ZLWK RQJRLQJ WUHDWPHQW ZHUH QRW DVVHVVHG 6LQFH KHSDWLWLV & LV WUHDWHG LQ VRPH UHJLRQV RXWVLGH +,9 WUHDWPHQW FHQWUHV WKHVH GDWD DUH WR D FHUWDLQ H[WHQW LQFRPSOHWH

2YHUDOO WUHDWPHQW UDWHV UHPDLQ ORZ IRU SDWLHQWV FRLQIHFWHG ZLWK KHSDWLWLV & YLUXV +&9 DQG +,9 ,Q WKH $XVWULDQ +,9 FRKRUW VWXG\ DW OHDVW RI WKH SDWLHQWV ZLWK FKURQLF KHSDWLWLV & DQG WKH SDWLHQWV

&+521,& +(3$7,7,6 % $1' &+521,& +(3$7,7,6 &

DEV OF EPID OVE

303

209

145

133

106

135

121

154

156

135

137

169

182

167

169

158

172

224

204

208

224

252

234

261

195

4553

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Total

1985

+,9

Number of positive HIV tests

Male

Female

85 987 989 991 993 995 997 999 001 003 005 007 009 19 1 1 1 1 1 1 1 2 2 2 2 2

100

150

200

Gender

85 987 989 991 993 995 997 999 001 003 005 007 009 19 1 1 1 1 1 1 1 2 2 2 2 2

100

150

200

250

300

Total

10. DEVELOPMENT OF THE HIV/AIDS EPIDEMIC OVER TIME

Number of positive HIV tests

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

Age at time of the first positive test

Median age at time of the HIV test

Age

Styria

Lower Austria

Upper Austria

Vienna

Missing

Tyrol

Burgenland Salzburg Foreign countries

Carinthia Vorarlberg

8 5 8 7 89 91 9 3 9 5 9 7 9 9 0 1 03 05 0 7 0 9 19 19 19 19 19 19 19 19 20 20 20 20 20

85 87 8 9 91 93 95 9 7 9 9 01 03 0 5 07 09 19 19 19 19 19 19 19 19 20 20 20 20 20

Federal state

100

120

N u m b e r o f p o s i ti v e H I V te s ts

65,1%

Lithuania Germany Austria Hungary Romania Slovakia Bosnia and Herzegovina Croatia Serbia Poland Russian Federation Albania Italy Ukraine Turkey Thailand India Viet Nam Armenia Georgia Egypt Liberia Congo Eritrea Cameroon Democratic Rep. of Congo Ghana Kenya Nigeria Uganda Zambia Algeria Guinea-Bissau Mozambique USA Dominican Republic Brazil Chile Missing

1 10 143 2 2 2 2 2 3 2 8 1 4 1 1 7 1 2 1 2 1 1 1 1 4 1 1 3 14 1 1 1 1 1 1 2 1 1 0

Germany Austria Bulgaria Hungary Romania Slovakia Bosnia and Herzegovina Croatia Poland Russian Federation Italy Belgium England Netherlands Portugal Slovenia France Turkey Thailand Myanmar Armenia Georgia Africa Egypt Gambia Congo Somalia Cameroon Gabon Ghana Guinea Kenya Nigeria Uganda Sierra Leone Mozambique America USA Missing

15 170 1 2 6 1 2 2 1 10 3 1 1 1 1 1 1 2 3 1 1 2 1 1 1 2 1 2 1 1 1 5 9 2 1 1 1 2 1

N=261

8,8%

Positive HIV test 2008

61,1%

6,9%

5,0%

11,1% 1,5% 1,5%

N=234

2,6%

Positive HIV test 2007

6,0%

7,7%

5,1%

4,3%

13,2%

Austria Eastern and Southeastern Europe Asia Others/missing 1,0%

N=195 Germany Austria Hungary Romania Czech Republic Bosnia and Herzegovina Croatia Serbia Poland Russian Federation Greece Italy England Portugal Slovenia Ukraine Turkey Afghanistan Pakistan Thailand Indonesia and Timor Georgia Africa Tanzania Zimbabwe Cameroon Ghana Burkina Faso Kenya Nigeria Guinea-Bissau Dominican Republic Missing

5 132 2 3 1 2 2 2 1 2 1 2 1 1 1 1 2 1 1 2 1 1 1 1 1 2 1 2 5 12 1 1 1

67,7%

Positive HIV test 2009

4,6%

8,7%

2,6% 2,1%

13,3%

Western Europe CIS-states Africa

10.1.1 Nationality: HIV diagnoses between 2007 and 2009

Source: EuroHIV + addition from AHIVCOS

l d nd en m nd UK urg any nce ece an tria and ark ga la ed lgiu ela o m ra re rl us nl m rtu e b e A Fi en o Ic Sw Be Ir m er F G itz P D xe G w u S L

70% 60% 50% 40% 30% 20% 10% 0%

Percentage of persons originating from high prevalence countries (prevalence at adults > 1%) among heterosexually infected persons newly diagnosed with HIV in 2006 in different European countries.

/RZ SUHYDOHQFH FRXQWULHV DUH FRXQWULHV ZLWK DQ +,9 LQIHFWLRQ UDWH RI DGXOWV KLJK SUHYDOHQFH FRXQWULHV DUH FRXQWULHV ZLWK DQ +,9 LQIHFWLRQ UDWH RI DGXOWV Â&#x2022;

10.1.2 Nationality of the heterosexually infected

10.1.3 Categories of heterosexual infection

Number of the positive HIV-tests

Sex with an IDU

Sex with a hemophilac

87 989 991 993 995 997 999 001 003 005 007 009 2 2 2 2 2 1 1 1 1 1 1

Sex with a MSM

Sub-categories of heterosexual contacts

Missing Originating from a high prevalence country Sex with a MSM Sex with an IDU Sex with a hemophilac Sex with person originating from a high prevalence country Sex wit HIV+ person not matching in the categories above Believes to be infected heterosexually

Sub-categories of heterosexual contacts

85 987 989 991 993 995 997 999 001 003 005 007 009 1 2 1 2 2 1 2 1 2 1 1 1

50 45 40 35 30 25 20 15 10 5 0

6XEW\SHV ZHUH GHWHUPLQHG E\ JHQRW\SLF UHVLVWDQFH WHVWLQJ RI 5HYHUVH 7UDQVFULSWDVH 57 DQG 3URWHDVH DFFRUGLQJ WR 6WDQIRUG GDWDEDVH ([DPSOHV RI WKH XVH RI WKH UHVLVWDQFH WHVW LQ 7\URO DQG 8SSHU $XVWULD DUH JLYHQ LQ WKH JUDSKV EHORZ

10.1.4 HIV-1 subtypes

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

World

Austria

Upper Austria

F, G, H, J, K

Tyrol

CRFAE

Styria

Other recombinants

Salzburg

CRFAG

Upper Austria

Not heterosexual

Tyrol

Heterosexual

Tyrol

All patients

Is the HIV test used ef ciently

1,0

153 2000

0,7 0,4 0,5 0,5

250 226 251 182

2006 2007

0,6

2008 2009

2005

0,6

204 2004

218

0,7 0,7

218 202

2002 2003

0,8

0,7

167 1999

170

0,6

166

2001

1,1

179

3,6 2,7

132 165

1995 1996 1998

3,6

129 1994

1997

7,2 3,5

136 147

1992 1993

9,0 4,1

121

98 116

>12 >12

120

1988 1989 1990

>12

130

1991

>12

186

1986 1987

>12

(0,

(1,

(0,

(3,

(7,

4) 2)

2, >12) 3, >12)

5, >12) 4, >12) 3, >12)

>12, >12) 8, >12)

7, >12) 10, >12)

>12, >12) >12, >12) >12, >12)

>12, >12) >12, >12)

>12, >12) >12, >12) >12, >12)

>12, >12) >12, >12)

(all >12)

All patients Months

259

124

170

0,9

1,5

2,9

4,7

2,7

2,2

1,1

5,2

1,9

6,5

0,5

3,7

7,5

3,7

5,5

0,9

7,8

2,4

0,5

10,7

>12

12,

(0,

(1, >12,

(0, >12,

(1,

(0, >12,

(1, >12,

(0, >12,

(1, >12,

(0, >12,

(0,

(0, >12,

(2, >12,

(8, >12,

10)

12)

>12)

(all >12)

IDU Months

Time between HIV test and first CD4 cell count measurement in months (median, percentiles 25, 75, 90)

1985

Year of HIV test

352

357

314

371

340

330

341

373

352

342

282

353

289

333

293

343

325

308

350

310

302

315

300

402

330

Median

(188 - 520)

(227 - 516)

(151 - 521)

(199 - 570)

(130 - 523)

(153 - 508)

(174 - 499)

(189 - 622)

(149 - 570)

(173 - 522)

(100 - 476)

(143 - 530)

(137 - 507)

(180 - 513)

(110 - 510)

(162 - 555)

(93 - 539)

(136 - 525)

(129 - 593)

(96 - 563)

(107 - 577)

(141 - 521)

(132 - 607)

(193 - 613)

(176 - 560)

Quartiles

First CD4 cell count (all patients, 228 missing)

$XVWULD KDV RQH RI WKH KLJKHVW UDWHV RI +,9 WHVWV LQ (XURSH VHH JUDSK 1HYHUWKHOHVV D VXEVWDQWLDO SRUWLRQ RI WKH SDWLHQWV DUH GLDJQRVHG ODWH DQG KDYH DGYDQFHG LPPXQH GHÂżFLHQF\ &' FHOO FRXQW Â&#x2014;O DW WKH WLPH RI WKHLU ÂżUVW FRQWDFW ZLWK DQ +,9 FHQWUH

10.1.

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<50

200-349

350-500

>500

2001

2002

2003

2004

2005

2006

2007

2008

2009

N.a./1.CD4-measurement >6 months after HIV test

Diagnosis AIDS within 3 months of testing HIV positive

50-199

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

CD4 count at first presentation

6HH DOVR KRPHSDJH RI WKH *HUPDQ $XVWULDQ 6ZLVV $,'6 &RQJUHVV 6g'$. KWWS DEVWUDFWV VRHGDN FRP FRQWHQWOLVW SKS

10.1.6 “Early” and “late” diagnoses

Percent of patients

100

150

200

All patients

Advanced diagnosis

Intermediate diagnosis

2007 2008 2009

Intermediate diagnosis

2004 2005 2006

Advanced diagnosis Early diagnosis

2001 2002 2003

IDU

Advanced diagnosis Early diagnosis

2001 2002 2003 2004 2005 2006 2007 2008 2009

2003 2004

Advanced diagnosis Early diagnosis

2001 2002

Intermediate diagnosis

2008 2009

Intermediate diagnosis

2005 2006 2007

Hetero

Advanced diagnosis Early diagnosis

2005 2006 2007 2008 2009

MSM

Early diagnosis

2001 2002 2003 2004

Intermediate diagnosis

2001 2002 2003 2004 2005 2006 2007 2008 2009

All patients

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

690 282 110 892

764

(11,97%) (23,77%) (17,38%) (3,64%) (11,55%)

(43,48%) (45,04%) (48,18%) (55,94%)

Univariate regression OR (95% CI) p-value

1,31 1,03 – 1,67 1 1,59 1,19 – 2,14

0,028

Model 1 (N = 1974) Multivariate regression* OR (95% CI) p-value

1,52 1,17 –1,96 1

0,001

0,002

1 2,39 1,82 – 3,13 1,61 1,11 – 2,33 0,29 0,10 – 0,80 1 0,31 1,51 1,23 1,01 3,14 1,53 0,12 0,77 1

0,11 1,04 0,72 0,67 2,14 1,04 0,02 0,30

– – – – – – – –

0,87 2,21 2,10 1,52 4,59 2,24 0,85 1,98

1,36 1,05 – 1,75 1 0,28 0,17 – 0,44 1

<0,001 0,012 0,017

1,85 1,33 –2,58 1,44 0,97 –2,15 0,23 0,08 –0,65 1

<0,001 0,073 0,005

0,027 0,031 0,448 0,950 <0,001 0,030 0,034 0,582

0,018

<0,001

0,003

0,42 0,24 – 0,75 1

0,012 -

1,65 1,12 – 2,44 -

Univariate regression p-value OR (95% CI)

0,62 0,52 – 0,74 1 0,88 0,72 – 1,07

<0,001

1,69 1,30 –2,21 1 0,30 0,18 –0,49 1

<0,001

Model 1 (N = 1974) Multivariate regression* p-value OR (95% CI)

0,58 0,48 –0,70 1

<0,001

0,201

1 0,61 0,50 – 0,74 0,65 0,49 – 0,84 0,73 0,49 – 1,09 1 0,86 1,27 1,62 1,32 1,09 1,25 1,10 0,67 1

0,54 0,95 1,09 1,00 0,78 0,93 0,64 0,36

– 1,35 – 1,69 – 2,40 – 1,75 – 1,52 – 1,68 1,90 – 1,24

1,21 1,01 – 1,45

<0,001 0,001 0,124

0,66 0,52 –0,84 0,77 0,58 –1,03 0,74 0,49 –1,11 1

<0,001 0,080 0,142

0,500 0,107 0,018 0,054 0,625 0,132 0,735 0,199

0,043

1 <0,001

1,48 1,14 –1,91 1

0,003

³/DWH´ GLDJQRVLV LV GH¿QHG DV &' FHOO FRXQW EHORZ DW WLPH RI +,9 GLDJQRVLV DQG RU $,'6 ZLWKLQ PRQWKV RI +,9 GLDJQRVLV

987 987

543

/ / / /

164 49 4 103

84 247 116 259 168 235 55 46 764

987 987

690 282 110 892

(51,93%)

/ / / /

300 127 53 499

84 247 116 259 168 235 55 46 764

(46,73%)

357 /

1,53 1,21 – 1,93 1

0,902 0,091 0,014

³(DUO\´ GLDJQRVLV RU ³UHFHQW´ LQIHFWLRQ LV GH¿QHG DV DFXWH +,9 LQIHFWLRQ ZHVWHUQEORW SDWWHUQ RU DQWLJHQ +,9 51$ FRPELQHG ZLWK FOLQLFDO SUHVHQWDWLRQ RU GRFXPHQWHG VHURFRQYHUVLRQ ZLWK QHJDWLYH +,9 WHVW QRW PRUH WKDQ \HDUV EHIRUH WKH ¿UVW SRVLWLYH WHVW

(18,03%) (14,39%)

178 / 142 /

65 /

(4,76%) (19,43%) (16,38%) (13,90%) (33,33%) (19,57%) (1,82%) (10,87%) (13,74%)

/ / / / / / / / /

4 48 19 36 56 46 1 5 105

(5,88%) (18,49%)

21 / 357 299 / 1617

(43,57%) (55,62%)

430 / 549 /

543

(42,86%) (52,63%) (58,62%) (53,67%) (48,81%) (52,34%) (49,09%) (36,96%) (46,73%)

/ / / / / / / / /

36 130 68 139 82 123 27 17 357

(58,26%) (47,68%)

208 / 357 771 / 1617

0,98 0,75 – 1,29 0,32 0,09 – 1,20 1,50 1,08 – 2,07 1

10.1.6.2 Risk factors for a “late” diagnosis (HIV diagnosis 2001-2009)

Frequencies N= 320 / 1974 (16,21%)

(17,82%)

255 / 1431

(17,77%) (13,74%)

215 / 1210 105 / 764

(19,72%) (0,00%) (5,88%) (12,94%)

/ 1349 / 13 / 357 / 255

266 0 21 33

Frequencies N= 979 / 1974 (49,59%)

(48,71%)

697 / 1431 282 /

(51,40%)

622 / 1210

(47,81%) (23,08%) (58,26%) (48,24%)

/ 1349 / 13 / 357 / 255

645 3 208 123

10.1.6.1 Risk factors for an “early” diagnosis (HIV diagnosis 2001-2009)

All centres Variable Demographic characteristics $JH < 38 years t 38 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDO VWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ KLJK DQG ORZ SUHYDOHQFH FRXQWULHV High prevalence countries Low prevalence countries 1DWLRQDOLW\ Austria Missing High prevalence countries Low prevalence countries * adjusted for the variable: gender

* adjusted for the variables: gender, area of residence

0,72 0,50 â&#x20AC;&#x201C;1,05 1 0,78 0,44 â&#x20AC;&#x201C;1,37 1

(4,90%) (6,82%) (3,93%) (6,02%)

59 / 1203 52 / 763 14 / 356 97 / 1610

61 / 575 (10,61%) 50 / 1391 (3,59%)

Patients still alive: Early: 264 203 Intermediate: 818 641 Advanced: 443 369

166 511 300

123 376 235

86 290 183

0,0

Years after HIV diagnosis

0,1

0,1 2

0,2

0,4 0,3

0,5 0,4 0,3

0,6

0,7

0,8

0,5 p<0,001

Advanced diagnosis

0,9

1,0

323 143 470 41

MSM

<0,001

0,027 <0,001 0,006

236 109 362 27

171 90 278 20

Others/ missing

Hetero IDU

2,61 1,78 â&#x20AC;&#x201C;3,81 1

0,50 0,27 â&#x20AC;&#x201C;0,93 2,84 1,75 â&#x20AC;&#x201C;4,63 2,52 1,31 â&#x20AC;&#x201C;4,84 1

Model 1 (N = 1966) Multivariate regression* p-value HR (95% CI)

Years after HIV diagnosis

p<0,001

<0,001

0,382

0,084

0,043 <0,001 <0,001

0,194

0,227

Patients still alive: MSM: 534 406 IDU: 223 185 Hetero: 703 572 Others: 65 50

Survival after the HIV test Early + intermediate diagnosis

0,6

0,7

0,8

0,9

1,0

2,78 1,91 â&#x20AC;&#x201C;4,04 1

0,56 0,32 â&#x20AC;&#x201C;0,98 2,85 1,85 â&#x20AC;&#x201C;4,39 3,02 1,59 â&#x20AC;&#x201C;5,72 1

688 (2,47%) 281 (13,88%) 105 (11,43%) 892 (4,82%)

/ / / /

1,34 0,86 â&#x20AC;&#x201C;2,08 1

(5,97%) (4,80%)

85 / 1424 26 / 542 17 39 12 43

0,79 0,54 â&#x20AC;&#x201C;1,16 1

(4,37%) (6,92%)

Univariate regression p-value HR (95% CI)

43 / 983 68 / 983

* adjusted for the variables: age, gender, area of residence, nationality

Stage of disease $GYDQFHG GLDJQRVLV Yes No

Variable Demographic characteristics $JH < 38 years t 38 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ KLJK DQG ORZ SUHYDOHQFH FRXQWULHV High prevalence countries Low prevalence countries

Frequencies N = 111 / 1966 (5,65%)

'DWH RI FHQVRULQJ ODVW FRQWDFW ZLWK WKH +,9 FHQWUH PLVVLQJ

Âł$GYDQFHGÂ´ GLDJQRVLV LV GHÂżQHG DV &' FHOO FRXQW EHORZ DW WLPH RI +,9 GLDJQRVLV DQG RU $,'6 ZLWKLQ PRQWKV RI +,9 GLDJQRVLV All centres

10.1.6.4 Risk factors for mortality after the HIV diagnosis (2001-2009)

987 987

Model 1 (N = 1974) Multivariate regression* p-value OR (95% CI)

All centres

<0,001

0,51 0,41 â&#x20AC;&#x201C;0,63 1

<0,001

(22,59%) (35,66%)

0,53 0,43 â&#x20AC;&#x201C; 0,64 1

0,518

223 / 352 /

(30,20%)

543

(21,01%) (26,24%) (37,27%) (35,31%)

690 282 110 892

Univariate regression p-value OR (95% CI)

Frequencies N= 575 / 1974 (29,13%)

Variable

84 247 116 259 168 235 55 46 764

0,93 0,75 â&#x20AC;&#x201C; 1,16

(28,72%)

411 / 1431

Demographic characteristics $JH < 38 years t 38 years *HQGHU Male

383 1 123 68

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDO VWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ KLJK DQG ORZ SUHYDOHQFH FRXQWULHV High prevalence countries Low prevalence countries 1DWLRQDOLW\ Austria Missing High prevalence countries Low prevalence countries

164 /

Female

<0,001 0,088 0,978

0,47 0,36 â&#x20AC;&#x201C;0,62 0,76 0,55 â&#x20AC;&#x201C;1,04 1,01 0,66 â&#x20AC;&#x201C;1,54 1

<0,001 0,005 0,686

/ / / /

145 74 41 315

0,49 0,39 â&#x20AC;&#x201C; 0,61 0,65 0,48 â&#x20AC;&#x201C; 0,88 1,09 0,72 â&#x20AC;&#x201C; 1,64 1

0,815 0,024 0,002 0,981 0,157 0,086 0,636 0,989

â&#x20AC;&#x201C; 1,58 â&#x20AC;&#x201C; 1,94 â&#x20AC;&#x201C; 2,88 â&#x20AC;&#x201C; 1,38 â&#x20AC;&#x201C; 1,87 â&#x20AC;&#x201C; 1,82 2,12 â&#x20AC;&#x201C; 1,96

0,56 1,05 1,28 0,73 0,90 0,96 0,63 0,51

(25,00%) (33,60%) (40,52%) (26,25%) (31,55%) (31,91%) (29,09%) (26,09%) (26,18%)

/ / / / / / / / /

21 83 47 68 53 75 16 12 200

0,94 1,43 1,92 1,00 1,30 1,32 1,16 1,00 1

0,022 (30,99%) (26,18%) 375 / 1210 200 / 764

1,27 1,03 â&#x20AC;&#x201C; 1,55 1

0,015 (34,45%) (27,95%) 123 / 357 452 / 1617

1,35 1,06 â&#x20AC;&#x201C; 1,73 1 (28,39%) (7,69%) (34,45%) (26,67%) / 1349 / 13 / 357 / 255

1,09 0,81 â&#x20AC;&#x201C; 1,47 0,23 0,03 â&#x20AC;&#x201C; 1,80 1,45 1,02 â&#x20AC;&#x201C; 2,06 1

0,574 0,161 0,041

10.1.6.3 Risk factors for an â&#x20AC;&#x153;advancedâ&#x20AC;? diagnosis (HIV diagnosis 2001-2009)

* adjusted for the variable: gender, area of residence and nationality - "high and low prevalence countries"

301

939

929 311

13 /

47 /

40 / 20 /

452 297

193 298

12 / 8 /

16 / 24 /

175 311 306 448

/ / / /

11 17 12 20

0,60 0,34 0,43

(6,22%) (2,68%) (3,54%)

(8,08%)

0,84 1

(4,32%) (5,01%)

(4,31%) (6,43%)

0,86

1,12 1,33 0,95 1

0,86 1

(4,23%) (4,97%)

9 / 213 51 / 1027

(6,29%) (5,47%) (3,92%) (4,46%)

0,57 1

(3,60%) (6,72%)

749 491

27 / 33 /

1,79 1,26 1,13 1

(5,61%) (5,43%) (4,44%) (3,96%)

481 184 45 530

/ / / /

27 10 2 21

1,58 1

(5,24%) (3,79%)

897 343

47 / 13 /

0,93 1

621 619

27 / 33 /

(4,35%) (5,33%)

0,49 â&#x20AC;&#x201C; 1,44

0,47 â&#x20AC;&#x201C;1,59

0,30 â&#x20AC;&#x201C;1,20 0,15 â&#x20AC;&#x201C;0,76 0,23 â&#x20AC;&#x201C;0,82

0,53 â&#x20AC;&#x201C;2,33 0,70 â&#x20AC;&#x201C;2,54 0,46 â&#x20AC;&#x201C;1,94

0,42 â&#x20AC;&#x201C;1,75

0,34 â&#x20AC;&#x201C;0,95

1,01 â&#x20AC;&#x201C;3,17 0,59 â&#x20AC;&#x201C;2,68 0,27 â&#x20AC;&#x201C;4,83

0,85 â&#x20AC;&#x201C;2,92

0,56 â&#x20AC;&#x201C;1,55

0,524

0,633

0,010

0,146 0,009

0,770 0,386 0,880

0,680

0,030

0,046 0,543 0,866

0,145

0,789

Univariate regress ion HR (95% CI) p-value

0,42 1

0,58 0,35

0,54 1

0,10 â&#x20AC;&#x201C; 3,49 0,15 â&#x20AC;&#x201C; 0,81 0,22 â&#x20AC;&#x201C; 0,80

0,32 â&#x20AC;&#x201C; 0,92

0,008

0,551 0,014

0,024

Model 1 (N = 1240) Multivariate regression* HR (95% CI) p-value

Patients without AIDS: Non-metropolitan: 659 543 Metropolitan: 451 379

455 325

361 250

279 179

174 281 171

134 216 140

100 166 107

HIV RNA >= 100 000

HIV RNA < 10 000

Years after HIV diagnosis

p=0,004

Patients without AIDS: <10 000: 262 205 Up to 99999: 402 338 Â&#x2022;100 000: 259 208

0,0

Years after HIV diagnosis

0,1

0,2

0,3

0,4

0,5

p=0,028

0,6

0,4

0,7

0,9

1,0

0,8

Metropolitan

Non-metropolitan

0,8

0,9

1,0

Time until AIDS (early + intermediate diagnoses only)

* adjusted f or the variables: age, gender, mode of transmission, nationality, first CD4 cell count, early diagnosis, HIV test until f irst contact

Health behavior (DUO\ GLDJQRVLV Yes No (interm ediate diagnos is) +,9 WHVW XQWLO ILUVW FRQWDFW P RQWKV <3,5 m onths (3. quartile) Â&#x2022;3,5 m onths (3. quartile)

10 000 - 99 999 copies/m l Â&#x2022;100 000 copies /m l

Stage of disease )LUVW &' FHOO FRXQW 1. CD4 cell count >6 m . after HIV test 200-349 350-499 Â&#x2022;500 )LUVW +,9 51$ Missing or >6 m . after HIV test <10 000 copies/m l

Variable Demographic characteristics $JH <36 years t36 years *HQGHU Male Fem ale 0RGH RI WUDQVP LVVLRQ MSM IDU Others/m is sing Hetero $UHD RI UHVLGHQFH Non-m etropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries

Frequencies N = 60 / 1240 (4,84%)

374 71 92 81 86 88 91 79 55 54 63 55 59 64 82 72 47 1513

AIDS <6 months Reported AIDS after HIV test cases AHIVCOS BMG 35,0% 1219 21,1% 172 31,5% 209 33,3% 142 37,2% 104 38,6% 99 44,0% 102 31,6% 88 43,6% 93 35,2% 97 44,4% 52 49,1% 71 50,8% 59 42,2% 64 46,3% 72 47,2% 70 55,3% 48 38,7% 2761 291 81 67 55 36 51 41 44 45 41 44 44 57 47 53 50 37 1084

All deaths AHIVCOS

198 52 46 37 21 31 22 26 30 22 25 24 33 25 33 19 19 663

AIDS-related deaths AHIVCOS

975 116 97 45 43 33 29 36 35 19 14 9 17 11 12 9 6 1506

AIDS-related deaths BMG

Missing/ abroad Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Total

65 19 22 66 425 83 97 248 84 404 1513

AIDS cases AHIVCOS

AIDS <6 months Reported AIDS cases after HIV test AHIVCOS BMG 44,6% 36,8% 32 63,6% 72 53,0% 173 32,5% 463 67,5% 120 60,8% 184 33,1% 274 47,6% 122 31,2% 1321 38,7% 2761

38 13 8 42 305 27 45 191 69 346 1084

All deaths AHIVCOS

29 9 4 19 243 15 20 128 41 155 663

AIDS-related deaths AHIVCOS

16 42 72 249 58 117 145 65 742 1506

AIDS-related deaths BMG

AIDS-Statistics: HIV Cohort Study vs. cases reported to Ministry of Health (BMG)

Before 1994 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

AIDS cases AHIVCOS

AIDS-Statistics: HIV Cohort Study vs. cases reported to Ministry of Health (BMG)

%HFDXVH PRVW RI WKH $,'6 FDVHV KDYH RFFXUUHG EHIRUH WKH XVH RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP DQG PDQ\ RI WKHVH SDWLHQWV KDYH GLHG WKH GRFXPHQWDWLRQ RI SDWLHQWV ZLWK $,'6 LV LQFRPSOHWH H[FHSWLRQV 7\URO DQG 8SSHU $XVWULD

3DWLHQWV ZLWK PLVVLQJ &' FHOO FRXQWV RU GDWH RI ÂżUVW FRQWDFW KDYH EHHQ H[FOXGHG IURP WKHVH FDOFXODWLRQV

All centres

$,'6

10.1.6.5 Risk factors for developing AIDS (early + intermediate diagnoses)

200

400

600

800

1000

1200

2002

2001

2000

2003

2004

100

2005

150

2006

Estonia Latvia Lithuania

2000

200

2001

2002

2003

250

Portugal UK Lux Belgium France Ireland Nether Austria Greece 2004

2004

300

2005

New HIV diagnoses 2000-2006 per million inhabitants

Undiagnosed HIV infections (estimate) (33.3% of all known HIV infections) Total

Patients without ART not in AHIVCOS (40% of the HIV infected without ART in AHIVCOS)

Patients without ART in AHIVCOS

Patients on ART not in AHIVCOS (33.3% of all treated)

Patients on ART in AHIVCOS (66.6% of all treated)

Malta Cyprus Poland Slovenia Bulgaria Czech R Romania Hungary Slovakia

Norway Denmark Sweden Finland Iceland Germany

6560

1639

540

1350

1011

2021

$ERXW WZR WKLUGV RI WKH SDWLHQWV RQ DQWLUHWURYLUDO WUHDWPHQW $57 LQ $XVWULD DUH UHJLVWHUHG LQ WKH FRKRUW VWXG\ 3HUVRQV ZLWK UHVLGHQFH LQ IRUHLJQ FRXQWULHV KDYH EHHQ H[FOXGHG IURP WKLV DQDO\VLV

+2: 0$1< +,9 ,1)(&7,216 $5( 7+(5( ,1 $8675,$"

2006

Source: ECDC

Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: ECDC

Total 313 339 428 402 442 423 470 453 442 515 505 507

BMG

Total 313 339 428 402 442 423 470 453 442 515 505 507

BMG

AHIVCOS

Drug Heterosexually users infected 17 (10,2%) 79 (47,3%) 23 (13,6%) 85 (50,3%) 33 (20,9%) 66 (41,8%) 30 (17,4%) 81 (47,1%) 42 (18,8%) 109 (48,7%) 31 (15,2%) 98 (48,0%) 34 (16,3%) 107 (51,4%) 33 (14,7%) 108 (48,2%) 33 (13,1%) 105 (41,7%) 37 (15,8%) 93 (39,7%) 24 (9,2%) 107 (41,0%) 18 (9,2%) 84 (43,1%) Others 12 (7,2%) 15 (8,9%) 12 (7,6%) 15 (8,7%) 14 (6,3%) 11 (5,4%) 8 (3,8%) 13 (5,8%) 12 (4,8%) 13 (5,6%) 12 (4,6%) 12 (6,2%)

Austria 137 82,0% 127 75,1% 124 78,5% 129 75,0% 175 78,1% 140 68,6% 147 70,7% 150 67,0% 163 64,7% 143 61,1% 170 65,1% 132 67,7%

Low prevalence countries 16 9,6% 23 13,6% 14 8,9% 13 7,6% 26 11,6% 22 10,8% 18 8,7% 21 9,4% 40 15,9% 40 17,1% 46 17,6% 29 14,9%

AHIVCOS High prevalence countries 13 7,8% 18 10,7% 19 12,0% 27 15,7% 21 9,4% 41 20,1% 43 20,7% 48 21,4% 49 19,4% 51 21,8% 44 16,9% 33 16,9%

Total 167 169 158 172 224 204 208 224 252 234 261 195

Missing 1 0,6% 1 0,6% 1 0,6% 3 1,7% 2 0,9% 1 0,5% 0 0,0% 5 2,2% 0 0,0% 0 0,0% 1 0,4% 1 0,5%

New HIV diagnoses in the AHIVCOS by nationality

Homosexual men 59 (35,3%) 46 (27,2%) 47 (29,7%) 46 (26,7%) 59 (26,3%) 64 (31,4%) 59 (28,4%) 70 (31,3%) 102 (40,5%) 91 (38,9%) 118 (45,2%) 81 (41,5%)

Total 167 169 158 172 224 204 208 224 252 234 261 195

Women 36 (21,6%) 61 (36,1%) 45 (28,5%) 48 (27,9%) 66 (29,5%) 63 (30,9%) 71 (34,1%) 62 (27,7%) 64 (25,4%) 58 (24,8%) 66 (25,3%) 45 (23,1%)

New HIV diagnoses in the AHIVCOS by mode of transmission and gender

New HIV diagnoses in the EU according to risks

10.4.1

172 224 204 208 224 252 234 261 195 1974

2001 2002 2003 2004 2005 2006 2007 2008 2009 Total

Year of HIV test

Number of HIV diagnoses

933

35 57 84 107 115 135 130 132 138

Available resistance tests before ART

2 3 5 7 8 12 7 7 14

Any resistance

Number of patients with resistance test before HIV therapy

The following codons and amino acids were classified as resistance (WHO):

VXUYHLOODQFH RI WUDQVPLWWHG +,9 GUXJ UHVLVWDQFH XSGDWH 3/R6 2QH H

Basics: 7KH UDWH RI WUDQVPLVVLRQ RI GUXJ UHVLVWDQW +,9 Â³SHUFHQW ZLWK UHVLVWDQFHÂ´ FRUUHVSRQGV WR WKH QXPEHU RI SDWLHQWV ZLWK UHVLVWDQFH PXWDWLRQV LQ UHODWLRQ WR WKH QXPEHU RI SDWLHQWV ZLWK D JHQRW\SLF UHVLVWDQFH WHVW )RU WKLV WKH JHQRPHV RI WKH UHYHUVH WUDQVFULSWDVH 57 DQG WKH SURWHDVH 3 ZHUH VHTXHQFHG *HQRW\SLF UHVLVWDQFH WHVWV ZHUH PRVWO\ GRQH DW WKH ,QVWLWXWH RI 9LURORJ\ DW WKH 0HGLFDO 8QLYHUVLW\ 9LHQQD 7KH UHVLVWDQFH PXWDWLRQV KDYH EHHQ FODVVLÂ¿HG DFFRUGLQJ WR %HQQHWW '( &DPDFKR 5- 2WHOHD ' HW DO 'UXJ UHVLVWDQFH PXWDWLRQV IRU

)RU WKLV DQDO\VLV RQO\ UHVLVWDQFH WHVWV ZKLFK KDYH EHHQ SHUIRUPHG EHIRUH WKH EHJLQQLQJ RI DQWLUHWURYLUDO WKHUDS\ ZHUH XVHG 3DWLHQWV ZHUH HLWKHU DQDO\VHG DFFRUGLQJ WR WKH WLPH RI WKH LQIHFWLRQ LI WKLV ZDV NQRZQ RU HVWLPDWHG Â³UHFHQW LQIHFWLRQÂ´ RU LI WKLV ZDV QRW NQRZQ SDWLHQWV ZHUH DQDO\VHG DFFRUGLQJ WR WKH \HDU RI WKH +,9 GLDJQRVLV

75$160,66,21 2) '58* 5(6,67$17 +,9

â&#x20AC;&#x17E;Recentâ&#x20AC;? infection (time of infection known or estimated)

175 52 6 110

343

Total

37 27 39 46 51 34 53 42 14

MSM IDU Others/missing Hetero

Mode of transmission

2001 2002 2003 2004 2005 2006 2007 2008 2009

Year of "recent" HIV infection

Number of "recent" HIV infections

206

112 26 4 64

17 12 23 32 31 24 29 28 10

Available resistance tests before ART

Â&#x2021; 0LGSRLQW EHWZHHQ ODVW QHJDWLYH DQG ÂżUVW SRVLWLYH +,9 WHVW

Â&#x2021; 7LPH SRLQW RI WKH DFXWH +,9 LQIHFWLRQ RU

&DOFXODWLRQ RI WKH WLPH RI LQIHFWLRQ \HDU RI WKH +,9 LQIHFWLRQ

7 2 5

2 1 2 2 3 3 1

Any resistance

Â&#x2021; 'RFXPHQWHG VHURFRQYHUVLRQ ZLWK D QHJDWLYH +,9 WHVW QRW PRUH WKDQ \HDUV EHIRUH WKH ÂżUVW SRVLWLYH WHVW

Â&#x2021; $FXWH +,9 LQIHFWLRQ ZHVWHUQEORW SDWWHUQ RU DQWLJHQ +,9 51$ ZLWK FOLQLFDO V\PSWRPV

Âł5HFHQWÂ´ LQIHFWLRQ PHDQV

)RU WKH DQDO\VLV RI WUDQVPLVVLRQ RI GUXJ UHVLVWDQW +,9 RQO\ UHVLVWDQFH WHVWV ZKLFK KDYH EHHQ SHUIRUPHG EHIRUH DQWLUHWURYLUDO WKHUDS\ ZDV VWDUWHG ZHUH XVHG 3DWLHQWV ZHUH HLWKHU DQDO\VHG DFFRUGLQJ WR WKH WLPH RI WKH LQIHFWLRQ LI WKLV ZDV NQRZQ RU HVWLPDWHG ÂłUHFHQW LQIHFWLRQÂ´ RU LI WKLV ZDV QRW NQRZQ SDWLHQWV ZHUH DQDO\VHG DFFRUGLQJ WR WKH \HDU RI WKH +,9 GLDJQRVLV

10.4.2 3-classresistance NNRTI and PI NRTI and NNRTI Resistance to NRTI and PI PI

NNRTI NRTI Any resistance Wild type Attempted Number of resistance Available HIV tests resistance infections before ART tests

1 1 1 1 1 1 1 3 2 1 1 2 1 2 1 1 1 2 1 2 2 3 3 1 15 12 22 30 29 24 26 25 9 17 12 23 32 31 24 29 28 10 18 12 25 32 31 25 32 30 10 37 27 39 46 51 34 53 42 14 2001 2002 2003 2004 2005 2006 2007 2008 2009

1 1 1 2 1 6 1 1 1 2 2 3 3 2 8 1 44 21 50 74 3 47 21 52 82 4 47 22 55 87 4 52 42 146 94 9 Central South East West Missing

1 1 1 1 1 5 1 2 2 2 2 1 2 7 2 5 105 24 4 59 112 26 4 64 118 28 4 65 175 52 6 110 MSM IDU Others/missing Hetero

1 1 1 2 7 1 4 4 1 12 2 153 39 165 41 174 41 272 71 Male Female

1 1 1 2

1 1 1 2 8 4 5

2 6 1 3 2 3 5 9 99 93 104 102

14 192 206 215 69

171 172

109 106

343 Total < 36 years Â&#x2022; 36 years

Age at time of HIV-test Gender

Mode of transmission Residence

Year of HIV infection 5HFHQW LQIHFWLRQV

Transmission of drug resistant HIV according to the time of the "recent" HIV infection, residence, mode of transmission, gender and age

514 226 103 777

1620

Total

143 191 168 162 182 211 195 205 163

MSM IDU Others/missing Hetero

Mode of transmission

2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of HIV diagnoses

722

245 72 35 370

22 44 65 77 90 105 103 100 116

Available resistance tests before ART

Unknown time of infection (not “recent”)

Year of HIV test

10.4.3

27 2 4 18

3 4 7 7 9 7 3 11

Any resistance

Transmission of drug resistant HIV according to the time of the HIV diagnosis, residence, mode of transmission, gender and age 1RW UHFHQW LQIHFWLRQV Attempted Number of resistance Available HIV tests resistance diagnoses before ART tests

Wild type

Any resistance

NRTI

NNRTI

Resistance to NRTI and PI PI

NRTI and NNRTI

NNRTI and PI

3-classresistance

Year of HIV diagnsis 2001 2002 2003 2004 2005 2006 2007 2008 2009

143 191 168 162 182 211 195 205 163

22 46 69 77 97 112 112 102 122

22 44 65 77 90 105 103 100 116

22 41 61 70 83 96 96 97 105

3 4 7 7 9 7 3 11

1 2 2 4 4 3 1 4

2 1 2 2 2 1 1

1 3 2 3 4 1 6

1 -

Residence Central South East West Missing

192 301 794 241 92

142 125 294 159 39

135 119 282 150 36

126 113 259 140 33

9 6 23 10 3

2 2 12 4 1

1 1 5 3 1

6 3 7 3 1

1 -

Mode of transmission MSM IDU Others/missing Hetero

514 226 103 777

249 78 36 396

245 72 35 370

218 70 31 352

27 2 4 18

9 2 2 8

9 2

10 2 8

1 -

Gender Male Female

1150 470

535 224

516 206

474 197

42 9

17 4

9 2

17 3

1 -

Age at time of HIV-test

1620

Total

809 811

< 34 years 34 years

344 415 759

325 397 722

302 369 671

23 28 51

10 11

6 5

8 12

1 1

ANTIRETROVI THERAPY (AR

VLHQW $57 GXULQJ DIWHU WKH DFXWH +,9 LQIHFWLRQ HWF

2Q -DQXDU\ SDWLHQWV ZHUH RQ DQWLUHWURYLUDO WKHUDS\ LQ WKH +,9 WUHDWPHQW FHQWUHV 2I WKH SDWLHQWV QRW RQ WUHDWPHQW RQ -DQXDU\ KDG UHFHLYHG DQWLUHWURYLUDO WUHDWPHQW DW DQ HDUOLHU SRLQW LQ WLPH ZRPHQ ZKR ZHUH RQ $57 WR SUHYHQW PRWKHU WR FKLOG WUDQVPLVVLRQ SDWLHQWV ZKR UHFHLYHG WUDQ-

(9,76%) (18,32%)

157 / 1608 175 / 955 53 / 312 279 / 2251

(16,99%) (12,39%)

(12,98%) (16,52%) (20,47%) (10,26%)

840 460 171 1092

109 76 35 112

/ / / /

(13,17%) (12,43%)

(15,46%) (10,45%)

237 / 1799 95 / 764

198 / 1281 134 / 1282

1,79 1,23 â&#x20AC;&#x201C;2,58 1

0,49 0,39 â&#x20AC;&#x201C;0,63 1

0,48 0,38 â&#x20AC;&#x201C;0,61 1 1,45 1,05 â&#x20AC;&#x201C;1,99 1

1,40 0,99 â&#x20AC;&#x201C;2,00 1,85 1,32 â&#x20AC;&#x201C;2,60 2,81 1,79 â&#x20AC;&#x201C;4,42 1

1,43 1,12 â&#x20AC;&#x201C;1,83 1

1,30 0,99 â&#x20AC;&#x201C;1,73 1,73 1,26 â&#x20AC;&#x201C;2,37 2,25 1,48 â&#x20AC;&#x201C;3,43 1

1,07 0,83 â&#x20AC;&#x201C;1,38 1

1,57 1,24 â&#x20AC;&#x201C;1,98 1

Model 1 (N= 2563) Frequencies N= Univariate regression Multivariate regression* OR (95% CI) 332 / 2563 (12,95%) OR (95% CI)

(5,16%) (11,91%) (9,29%) (7,37%)

55 / 1065 71 / 596 17 / 183 109 / 1478

/ / / /

(7,67%) (7,38%) (6,10%) (10,98%) (16,92%) (5,19%)

30 38 22 36

90 / 1173 36 / 488

(6,88%) (8,29%)

492 346 130 693

* adjusted for the variables: age, gender

Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries

57 / 829 69 / 832

Frequencies N= 126 / 1661 (7,59%)

0,37 0,25 â&#x20AC;&#x201C;0,54 1 2,03 1,10 â&#x20AC;&#x201C;3,75 1

1,29 0,75 â&#x20AC;&#x201C;2,20 1

1,15 0,64 â&#x20AC;&#x201C; 2,07 2,36 1,41 â&#x20AC;&#x201C;3,94 4,57 2,46 â&#x20AC;&#x201C;8,48 1

Model 1 (N= 1661) Multivariate regression* OR (95% CI)

0,40 0,28 â&#x20AC;&#x201C;0,58 1

1,19 0,72 â&#x20AC;&#x201C;1,95 2,25 1,40 â&#x20AC;&#x201C;3,62 3,72 2,11 â&#x20AC;&#x201C;6,56 1

1,04 0,70 â&#x20AC;&#x201C;1,56 1

0,82 0,57 â&#x20AC;&#x201C;1,18 1

Univariate regression OR (95% CI)

Risk not to receive ART despite a CD4 nadir <200 and/or AIDS

Variable Demographic characteristics $JH <45 years t 45 years *HQGHU

All centres

11.2.2

* adjusted for the variable: gender

High prevalence countries Low prevalence countries

Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\

Variable Demographic characteristics $JH <44 years t 44 years *HQGHU

All centres

11.2.1

180%(5 2) 3$7,(176 21 $17,5(7529,5$/ 7+(5$3< Risk not to receive ART despite a CD4 nadir <350 and/or AIDS

$&&(66 72 $17,5(7529,5$/ 7+(5$3<

11. ANTIRETROVIRAL THERAPY (ART)

0,19 (0,15 –0,23) 1

0,82 (0,62 –1,08) 0,80 (0,64 –0,99) 1

1,79 (1,23 –2,58) 1 Not applicable

2,46 (1,88 –3,21) 1

(0,40 –0,75)

Not applicable

0,49 (0,39 –0,63) 0,55 1 1

0,36 (0,30 –0,43) 1

(0,53 –1,24) (1,25 –2,84) (0,41 –1,91)

OR (95% CI)***

1,40 (0,99 –2,00) 0,81 1,85 (1,32 –2,60) 1,89 2,81 (1,79 –4,42) 0,88 1 1

1,43 (1,12 –1,83) 1

OR (95% CI)**

Risk factors for Risk factors for starting ART not receiving ART with a CD4 <200 despite a more than 6 months CD4 nadir <350 after the HIV and/or AIDS diagnosis

0,89 (0,70 –1,14) 1,47 (1,14 –1,89) 2,32 (1,64 –3,30) 1

1,34 (1,08 –1,68) 1

OR (95% CI)*

*** adjusted for the variables: age, gender and nationality

** adjusted for the variables: gender

* adjusted for the variables: age

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHD RI UHVLGHQFH Non-metropolitan area Metropolitan city 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease &' QDGLU Missing 50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57 XVH HYHU Yes No

Variable Demographic characteristics $JH <43/44/43 years t 43/44/43 years *HQGHU Male Female

Risk factors for no follow-up in the last 6 months

Summary of indicators of access to ART and health care

All centres

11.2.3

Use of therapy regimens over time

10%

15%

20%

25%

30%

35%

40%

45%

3 NRTI 1+ NNRTI & 1+ PI No ART use

2+ NRTI & 1+ PI (All) 3 classes

er ap y

NR TI &

NR 1+ PI

TI &

RT I

TI NN

NR 1+

(A ll) 3

cla

ss es

PI (M on

RT I&

TI & 1+ PI

Therapy regimens on January 1, 2010

Other HIV therapies PI (Mono) 1+ PI & 1+ InI

PI & In

O th

er s

2+ NRTI & 1+ NNRTI 2 NRTI & 1+ InI

12 06 12 06 12 06 12 06 06 06 12 12 06 12 12 06 12 11717171177117717/0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 /0 1 2 3 3 2 4 4 5 6 5 6 7 8 7 8 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SDWLHQWV KDYH FXUUHQWO\ 3, 0RQR

5(*,0(16 2) 7+( $17,5(7529,5$/ 7+(5$3<

d an nl e g ur B

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total

Miss.

For. c.

Other HIV therapies PI (Mono) 1+ PI & 1+ InI

g ur zb al S

1,0%

,0%

,5%

,0%

1,0%

,8%

2,1%

,0%

2,3%

,0%

ria ty S

ng si is M

5,6%

115

,0%

5,9%

9,3%

3,8%

5,0%

6,3%

5,3%

,0%

Others

l ta To

100,0%

2039

100,0%

649

100,0%

290

100,0%

240

100,0%

141

100,0%

336

100,0%

151

100,0%

Total

2+ NRTI & 1+ NNRTI 2 NRTI & 1+ InI

,8%

,0%

,5%

2,4%

1,4%

,8%

,7%

,9%

,7%

,0%

1+ PI & 1+ InI

a es tri nn ie un V o c gn ei r Fo

1,6%

,0%

1,5%

,0%

1,0%

,0%

,7%

3,9%

2,6%

1,1%

,0%

2 NRTI & 1+ InI

2+ NRTI & 1+ PI (All) 3 classes

g er lb ar r o V

,2%

,0%

,2%

,0%

1,3%

,0%

1,1%

,0%

1+ NNRTI & 1+PI

l ro Ty

1,7%

,0%

3,9%

,0%

,9%

3,3%

,0%

4,2%

PI (Mono)

Therapy regimen

(All) 3 classes

3 NRTI 1+ NNRTI & 1+ PI No ART use

,6%

,0%

,8%

,0%

2,1%

,7%

,0%

3 NRTI

a a ia tri tri th us us in A A ar C er er w pp Lo U

856

42,0%

948

23,5%

76,5%

46,5%

77,8%

22,2%

276

42,5%

288

25,9%

65,9%

44,4%

28,3%

59,0%

47,1%

46,3%

171

113

44,0%

47,5%

111

41,7%

42,3%

140

49,7%

37,7%

142

60,2%

35,2%

62,5%

33,3%

2+ NRTI & 1+ NNRTI

2+ NRTI & 1+PI

Therapy regimens in the current cohort

385

Zidovudin

134

202

01.01.02

357

288

01.01.02

330

294

131

158

01.01.05

307

416

01.01.05

433

595

255

412

350

163

208

01.01.06

312

437

01.01.06

431

782

119

1312

174

117

488

01.01.06

Maraviroc

Enfuvirtide

Entry-/ fusion inhibitors

01.01.02

01.01.05

01.01.06

11.4.4 Use of entry-/ fusion inhibitors y

Ritonavir as booster

Tipranavir

Saquinavir

Lopinavir/r

Indinavir

Fosamprenavir

Darunavir 600 mg

Darunavir 400 mg

Darunavir

Atazanavir

11.4.3 Use of PI

Nevirapin

Etravirin

Efavirenz

NNRTI

11.4.2 Use of NNRTI

567

Tenofovir

Stavudin

35 1238

931

224

412

01.01.05

Lamivudin

310

277

01.01.02

Use of NRTI

Emtricitabin

Didanosin

Abacavir

NRTI

11.4.1

01.01.07

492

501

147

286

01.01.07

297

471

01.01.07

353

962

1286

420

581

01.01.07

$'0,1,67(5(' $17,5(7529,5$/ '58*6

1255

871

1061

631

224

530

01.07.08

228

544

01.01.09

270

616

01.01.10

383

537

245

01.07.08

430

528

292

01.01.09

611

441

101

134

214

339

01.01.10

01.07.08

01.01.09

01.01.10

Number of patients treated with the drug 01.01.08

562

650

154

313

121

1009

944

747

637

01.01.10

Number of patients treated with the drug 01.01.08

295

500

141

898

1020

606

671

01.01.09

Number of patients treated with the drug 01.01.08

294

1058

1341

577

702

01.07.08

Number of patients treated with the drug 01.01.08

126

412

400

563

268

01.01.07

106

569

557

512

233

Tenofovir + Didanosin

162

410

331

01.01.05

407

172

511

409

01.01.06

324

417

476

533

01.01.07

112

492

567

326

106

01.07.08

273

571

431

195

549

548

287

01.01.09

3HUFHQWDJH ZLWK FXUUHQW +,9 51$ t FRSLHV PO

NRTI-, NNRTI- and PI-drugs ever received

318

740

564

233

01.01.10

131

604

256

646

01.07.08

112

745

223

613

01.01.09

803

(39,4%)

(N= 2430) (34,1%)

(N = 2039)

Current cohort

829

Current cohort and current ART

1060

165

613

01.01.10

Number of patients treated with the drug

01.01.08 663

128

01.01.10

11.4.8 Number of patients who have ever received NRTI-, NNRTI- and PI-drugs

232

Stavudin + Lamivudin

Abacavir + Zidovudin

407

Zidovudin + Lamivudin

Tenofovir + Emtricitabin

Didanosin + Lamivudin

321

Tenofovir + Lamivudin

Tenofovir + Abacavir

289

01.01.04

Abacavir + Lamivudin

NRTI

01.01.09

Number of patients treated with the drug

01.01.08

01.07.08

Number of patients treated with the drug

01.01.08

0RVWO\ D FRPELQDWLRQ RI 157, LV XVHG KRZHYHU DW OHDVW SDWLHQWV UHFHLYH Â&#x2022; 157,

11.4.7 Use of NRTI combinations

"Atripla"

251

"Ziagen"

346

237

"Trizivir"

143

738

337

"Truvada"

"Retrovir"

832

340

01.01.06

172

605

"Epivir"

01.01.05

"Kivexa"

286

"Combivir"

01.01.02

11.4.6 Use of commercial preparations

Raltegravir

01.01.06

% 93,8 24,0

2003 2004 2005 2006 2007 2008 2009

% of patients with ART interruptions 8,7% 4,6% 7,2% 5,3% 3,9% 4,1% 2,6%

2003

2004

2005

2006

2007

2008

2009

0,00

0,02

0,04

0,06

0,08

0,10

0,12

0,14

2003

2004

2005

2006

2007

2008

2009

Number of ART interruptions in the respective year

0,00

0,05

0,10

0,15

0,20

0,25

0,30

0,35

0,40

0,45

0,50

Number of ART switches in the respective year

% of patients with ART switches 28,7% 27,4% 27,3% 31,3% 23,8% 25,4% 23,4%

Percentage of patients with ART switches and interruptions

N=1061 (the rapy starte d be fore 1.1.2004) Pers ons with treatm ent s witc hes since 2003 Pers ons with treatm ent interruptions since 2003

7KH FDOFXODWLRQV LQFOXGH DOO SDWLHQWV LQ WKH FXUUHQW FRKRUW ZKR KDYH LQLWLDWHG WKHUDS\ EHIRUH

01.01.05

Integrase inhibitor

01.01.02

$57 6:,7&+(6 $1' ,17(55837,216 3(5 &$/(1'$5 <($5

11.4.5 Use of integrase inhibitors

Mean treatment changes per patient Mean treatment interruptions per patient

(25,00%) (23,98%)

(24,16%) (23,94%)

15 / 60 240 / 1001

108 / 447 147 / 614

64 / 260 100 / 458 91 / 343

&' QDGLU <50 cells/Îźl 50-199 cells/Îźl t200 cells/Îźl

0,90 0,62 â&#x20AC;&#x201C;1,31 0,77 0,56 â&#x20AC;&#x201C;1,07 1

1R ULVN IDFWRUV ZHUH LGHQWLÂżHG

0,594 0,123

0,934

1,01 0,76 â&#x20AC;&#x201C;1,35 1

0,857

1,61 0,63 0,40 0,53 0,89 0,55 -

1,06 0,58 â&#x20AC;&#x201C;1,93 1

3,15 0,97 0,74 0,91 1,35 0,89 1

<0,001 0,892 0,320 0,718 0,155 0,626 3,60 0,91 0,87 0,88 1,16 0,87 1

1,81 0,57 0,47 0,51 0,75 0,53 â&#x20AC;&#x201C;7,17 â&#x20AC;&#x201C;1,44 â&#x20AC;&#x201C;1,64 â&#x20AC;&#x201C;1,54 â&#x20AC;&#x201C;1,81 â&#x20AC;&#x201C;1,45 -

0,359 1,05 0,68 â&#x20AC;&#x201C;1,63 <0,001 2,10 1,39 â&#x20AC;&#x201C;3,16 0,624 0,95 0,51 â&#x20AC;&#x201C;1,77 1

0,002 0,69 0,48 â&#x20AC;&#x201C; 0,983 1

â&#x20AC;&#x201C;6,16 â&#x20AC;&#x201C;1,49 â&#x20AC;&#x201C;1,35 â&#x20AC;&#x201C;1,55 â&#x20AC;&#x201C;2,05 â&#x20AC;&#x201C;1,44

0,85 0,60 â&#x20AC;&#x201C;1,20 1,95 1,35 â&#x20AC;&#x201C;2,82 0,87 0,49 â&#x20AC;&#x201C;1,54 1

11.5.2 Risk factors for treatment switches since 2003

* adjusted for the variables: nationality, AIDS, duration of therapy

(24,62%) (21,83%) (26,53%)

(48,78%) (22,68%) (18,18%) (21,50%) (29,03%) (21,13%) (0,00%) (0,00%) (23,21%)

/ / / / / / / / /

20 44 16 23 54 30 0 0 68

(19,94%) (36,36%) (20,24%) (22,66%)

41 194 88 107 186 142 0 10 293

/ 331 / 187 / 84 / 459

66 68 17 104

0,64 0,48 â&#x20AC;&#x201C;0,85 1

(21,16%) (29,69%)

149 / 704 106 / 357

<0,001 0,675 0,673 0,666 0,508 0,599 -

0,823 <0,001 0,881

0,040

<0,001

1,63 1,22 â&#x20AC;&#x201C;2,17 1

(28,44%) (19,62%)

151 / 531 104 / 530 <0,001 1,72 1,27 â&#x20AC;&#x201C;2,33 1

Model 1 (N = 1061) Univariate regression Multivariate regression* OR (95% CI) p-value OR (95% CI) p-value

Frequencies N= 255 / 1061 (24,03%)

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero )HGHUDO VWDWH Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Missing Foreign countries Vienna 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No

Variable Demographic characteristics $JH <47 years t47 years *HQGHU Male Female

All centres

11.5.1 Risk factors for treatment interruptions since 2003

$IWHU -XO\ SDWLHQWV VWDUWHG DQWLUHWURYLUDO WKHUDS\ RI WKHP DOVR KDG WKHLU ÂżUVW PHDVXUHPHQW RI &' FHOO FRXQW ZLWKLQ WKLV SHULRG 7KH PRVW IUHTXHQW WKHUDS\ UHJLPHQ XVHG ZDV WKH FRPELQDWLRQ 157, ZLWK 3,

11.6.1 Regimens of the initial therapy

,1,7,$/ 7+(5$3< $)7(5 -8/<

100

150

200

250

300

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of persons who started ART in the respective year

1,0

1,2

1,4

1,6

1,8

2,0

Mean 1,5

Âą S.D. Âą 0,8

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Beginning of therapy

Number of the different regimens during the first year of treatment

N= 1396 Number of therapy regimes during the first year of treatment

The following calculations include patients of the current cohort who currently receive therapy that was started between January 1, 1997 and January 1, 2009.

Cohort participants with initial ART

11.6.2 Switching of ART during the rst year of treatment

Number of regimens (mean + 95% CI)

32 40

Tenofovir Zidovudin

Nevirapin

116

115

(N = 143)

Number of patients treated with the drug

(N = 124 )

(N = 102)

(N = 111)

(N = 149)

(N = 124)

(N = 143 )

Number of patients treated with the drug

(N = 124)

Saquinavir Ritonavir as Booster

Lopinavir/r

(N = 124)

(N = 149)

(N = 124)

(N = 143)

(N = 111)

Fosamprenavir

(N = 102)

(N = 93)

Darunavir

Atazanavir

(N = 149)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

(N = 93) Efavirenz

Study drug

(N = 124)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

Stavudin

(N = 111)

(N = 102)

Lamivudin

(N = 93)

NNRTI

Number of patients treated with the drug 1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

Emtricitabin

Didanosin

Abacavir

NRTI

11.6.3 Antiretroviral drugs in the initial therapy

(N = 102)

(N = 111)

(N = 124) 1

(N = 143 )

(N = 102)

(N = 111)

(N = 149)

(N = 124) 12

(N = 143 )

Number of patients treated with the drug

(N = 124)

"Ziagen"

"Trizivir"

"Truvada"

(N = 111)

"Retrovir"

(N = 102)

"Kivexa"

(N = 93)

(N = 124)

(N = 149)

(N = 124)

(N = 143)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

(N = 93)

"Epivir"

(N = 149)

Number of patients treated with the drug

(N = 124)

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

(N = 93)

"Atripla"

Number of patients treated with the drug

1. ART 03/2 1. ART 04/2 1. ART 05/2 1. ART 06/2 1. ART 07/2 1. ART 08/2 1. ART 09/2

"Combivir"

Raltegravir

Integrase inhibitors

Maraviroc

Entry-/fusion inhibitors

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Efavirenz

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Tenofovir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Abacavir

0,5

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,5

2,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

1,0

0,5

1,0

NOT INITIAL

0,5

NOT INITIAL

0,5

NOT INITIAL

1,5

'58* ',6&217,18$7,21 :,7+,1 <($56 2) 67$57,1* $ '58* 6,1&(

2,0

88 1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Lopinavir/r

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

0,5

Fosamprenavir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Atazanavir

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

Nevirapin

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,0

INITIAL

1,5

2,0

1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,0

0,5

1,0

NOT INITIAL

0,5

1,0

NOT INITIAL

0,5

NOT INITIAL

0,5

NOT INITIAL

1,5

2,0

Reasons for discontinuation of drugs in the initial therapy (since 2004, in %) Abacavir

INITIAL THERAPY Treatment failure (i.e. virological, immunological, and/or clinical failure) Virological failure Partial virological failure Immunological failure - CD4 drop Clinical progression Abnormal fat redistribution Concern of cardiovascular disease Dyslipidaemia Cardiovascular disease Hypersensitivity reaction Toxicity, predominantly from abdomen/ GI tract Toxicity - GI tract Toxicity - Liver Toxicity - Pancreas Toxicity, predominantly from nervous system Toxicity, predominantly from kidneys Toxicity, predominantly from endocrine system Diabetes Haematological toxicity (anemiaâ&#x20AC;Ś etc.) Hyperlactataemie/lactic acidosis Death Side effects - any of the above but unspecified Comorbidity Toxicity, not mentioned above Availability of more effective treatment (not specifically failure or side effect related) Simplified treatment available Treatment too complex Drug interaction Structured Treatment Interruption (STI) Structured Treatment Interruption (STI) - at high CD4 Patient's wish/ decision, not specified above Non-compliance Physician's decision, not specified above Pregnancy Study treatment Other causes, not specified Unknown Total

2,4

4,3

0,7

7,5

3,3

1,6

Tenofovir

Emtricitabin/ Lamivudin

0,3

0,3 4,8

9,5 2,4

2,4

Nevirapin

12,0

0,7

Efavirenz

Fosamprenavir

Atazanavir

6,1 3,0

Lopinavir/r

2,2 0,6 0,6

1,1

0,6 0,6

1,1 2,2

0,7 5,2 0,7 0,7

0,9 0,3 0,6 5,4 0,3 0,9

0,7 9,2

0,6 2,8

2,0 0,7 0,7

0,9 3,5 1,3 0,9

16,0 4,0 12,0

3,2 2,9 8,6 1,1

6,1 6,1 6,1

11,6 14,9 1,1

17,2 3,0

2,4

2,4 4,8 2,4 16,7 11,9 16,7 4,8 4,8 9,5 100%

1,3

10,7 0,3 0,6 3,5 0,6 17,0 10,4 19,9 2,2 0,3 6,3 4,4 100%

1,3

1,6

4,0

11,4 2,9 2,9

11,8

1,1

4,0

0,7 2,6

8,0 100%

6,1

1,1 5,0

2,9

1,1

12,0 4,0 24,0

18,3 14,4 24,8 0,7 5,9 5,3 100%

34,3

2,2 2,2 1,1 16,1 7,5 16,1

2,9 5,7 8,6 11,4

4,3 2,2 100%

5,7 100%

3,0 3,0 3,0 15,2 18,2 15,2

3,0 3,0 100%

9,9 1,1 1,1 2,8 0,6 13,3 11,0 7,2 2,2 0,6 5,0 5,0 100%

NOT INITIAL THERAPY

Reasons for discontinuation of drugs in not-initial therapy (since 2004, in %) Abacavir

Treatment failure (i.e. virological, immunological, and/or clinical failure) Virological failure Partial virological failure Immunological failure - CD4 drop Clinical progression Abnormal fat redistribution Concern of cardiovascular disease Dyslipidaemia Cardiovascular disease Hypersensitivity reaction Toxicity, predominantly from abdomen/ GI tract Toxicity - GI tract Toxicity - Liver Toxicity - Pancreas Toxicity, predominantly from nervous system Toxicity, predominantly from kidneys Toxicity, predominantly from endocrine system Diabetes Haematological toxicity (anemiaâ&#x20AC;Ś etc.) Hyperlactataemie/lactic acidosis Death Side effects - any of the above but unspecified Comorbidity Toxicity, not mentioned above Availability of more effective treatment (not specifically failure or side effect related) Simplified treatment available Treatment too complex Drug interaction Structured Treatment Interruption (STI) Structured Treatment Interruption (STI) - at high CD4 Patient's wish/ decision, not specified above Non-compliance Physician's decision, not specified above Pregnancy Study treatment Other causes, not specified Unknown Total

3,9

2,0 3,9

8,3

1,3

Efavirenz

Emtricitabin/ Lamivudin

Tenofovir

1,3 1,3

Nevirapin

10,0

Fosamprenavir

Atazanavir

Lopinavir/r

4,2 5,1

2,6 2,6 9,1

3,9 7,8 2,0 3,9

1,3

3,2 30,0

2,9

1,3 9,2

2,9

3,9

2,9 2,9

1,3 3,9 1,3

4,2 20,0

9,1 9,1

8,3

5,6 2,8 8,3

5,1 5,1 5,1

8,3 5,1

4,2

5,6

2,0

2,8

2,0 7,8

10,0

20,0 2,9 100%

15,8 2,6 100%

10,0 10,0

22,9 11,5 28,6 2,9

21,1 13,2 13,2

19,6 17,6 2,0 2,0 2,0 9,8

1,3

2,0 2,0

3,9

100%

16,7

9,1

27,3

5,6 2,8 2,8

100%

16,7 16,7 8,3 4,2

9,1 9,1 18,2

25,0 8,3 19,4 2,8 8,3

100%

7,7

10,3 17,9 5,1 15,4 5,1 5,1 2,6 100%

30%

20%

10%

30%

20%

10%

0% 0

40%

10%

20%

30%

40%

50%

2 50%

3 0

Fig. 3

2 3 4

Fig. 2

Total

HIV-RNA Â&#x2022;400

4 (4,6%) 1153 28 (2,4%)

1153

2430

Total

0 (0,0%) 2039 66 (3,2%)

HIV-RNA Â&#x2022;400

201

Dosing frequency of drugs other than ARVs

7 (4,0%)

0 (0,0%)

HIV-RNA Â&#x2022;400

175

418

Overall dosing frequency in patients with once daily ARVs

Dosing frequency of ARVs

Fig. 1

5 (1,5%) 175

HIV-RNA Â&#x2022;400

40%

50%

557 12 (2,2%) 334

1153 28 (2,4%) 866 38 (4,4%)

HIV-RNA Â&#x2022;400

334

969

873

(HIV-RNA Â&#x2022; 400: persons with at least 2.5 months between ART beginning and measurement of viral load)

Overall dosing frequency in patients with once daily ARVs

Dosing frequency of ARVs N

557

670

1153

Number of daily drug doses

Frequency of virologic failure related to dosing frequency

172

Drugs other than ARVs (Fig. 2)

Drugs other than ARVs in patients with once daily ARVs (Fig. 3)

384

Antiretrovirals (ARVs) (Fig.1) 0

)5(48(1&< 2) '58* '26,1*

505 (43,6%)

Any resistance

Chi-square-test T-test not significant, p>0,10

167 (14,4%)

IDU versus others

* ** n.s.

434 (37,5%)

102 (8,8%)

396 (34,2%)

337 (29,1%)

339 (29,3%)

MSM versus others

Mode of transmission

High prevalence countries

Nationality

Metropolitan

Area of residence

Women

Gender

AIDS

32 (2,8%)

44,3

Mean age

3-class-resistance

81,7

Mean duration of ART (months)

188,1

95 (8,2%)

>50

Mean CD4 nadir

28 (2,4%)

164 (18,6%)

256 (29,0%)

106 (12,0%)

253 (28,7%)

299 (33,9%)

336 (38,1%)

104 (11,8%)

478 (54,2%)

45,2

98,0

161,8

102 (11,6%)

38 (4,3%)

N= 882

N= 1157

400

HIV RNA ( 2.5 months between ART+HIV RNA-measurement)

ART twice daily

ART once daily

HIV drug intake once daily versus twice ( twice) daily (current cohort and current ART)

0,01

<0,01

0,02

<0,01

0,02

<0,01

0,07 **

<0,01 **

0,01

0,02

p-value*

108 152 58

Anxiolytics, hypnotics, sedatives Antidepressants Antipsychotics

(5,0%)

(13,1%)

(9,3%)

(20,1%)

(8,7%)

(3,5%)

(2,3%)

(9,6%)

(1,5%)

(0,9%)

(2,4%)

(13,4%)

(6,2%)

(11,1%)

(7,3%)

women only (ART once daily: N=337, ART twice daily: N=299) 2 MSM only (ART once daily: N=434, ART twice daily: N=256)

101 232

Current therapy with psychotropic drugs

Thyroid hormones Current opiate substitution

Bisphosphonates

111

10 17

155

128

N= 1157

Oral antidiabetics Proton pumpe inhibitors

(9,6%)

(1,0%)

(1,9%)

(1,0%)

(12,9%)

(3,8%)

(5,3%)

(1,4%)

(5,3%)

(6,5%)

(1,8%)

(8,9%)

(3,0%)

(0,1%)

(1,5%)

(2,2%)

(3,2%)

ART once daily

Insulin

Fibrate

Statin

Beta blocker

ACE-inhibitors/ angiotensin antagonists

Acetylsalicyl acid

Current medication other than ART

111

Drug overdose (mainly opiates) Opiate dependency

Attempted suicide or suicide

149

Chronic hepatitis C (currently) HCV-related liver cirrhosis

61 44

Chronic hepatitis B (currently)

Osteoporosis

Anal cancer (MSM)

Anal intraepithelial neoplasia II, III2

St. p. hysterectomy

Invasive cervix cancer1

Diabetes mellitus Type II CIN II or CIN III or carcinoma in situ

Stroke Diabetes mellitus Type I

37 25

Myocardial infarction

(12,7%)

(2,0%)

(2,6%)

(3,6%)

(19,3%)

(2,7%)

(9,3%)

(3,5%)

(7,0%)

(6,7%)

(1,0%)

(13,0%)

(5,1%)

(0,3%)

(1,2%)

(2,7%)

(4,5%)

(13,5%)

151

228

121

131

125

(7,1%)

(17,1%)

(10,5%)

(25,9%)

(13,7%)

(6,2%)

(3,9%)

(14,9%)

(2,2%)

(1,6%)

(3,2%)

(14,2%)

(6,5%)

(10,9%)

(7,8%)

N= 882

ART twice daily

112

170

119

N= 882

(11,1%)

N= 1157 128

ART twice daily

ART once daily

Coronary heart disease

Hypertension

Cumulative incidence/ current diseases

0,04

0,01

n.s.

<0,01

0,05

<0,01

n.s.

p-value*

0,03

0,04

n.s.

<0,01

n.s.

<0,01

n.s.

0,02

n.s.

0,10

p-value*

BENEFITS O ANTIRETROV THERAPY

6HH DOVR KRPHSDJH RI WKH *HUPDQ $XVWULDQ 6ZLVV $,'6 &RQJUHVV 6g'$. KWWS DEVWUDFWV VRHGDN FRP FRQWHQWOLVW SKS

7KH JUDSKV EHORZ VKRZ VXUYLYDO LQ SDWLHQWV ZLWK $,'6 ,Q Â¿JXUH $ WKH SDWLHQWV RI WKH +,9 WUHDWPHQW FHQWUHV /LQ] DQG ,QQVEUXFN ZHUH FHQVRUHG RQ -DQXDU\ LQ Â¿JXUH % ZLWK WKH ODVW FRQWDFW WR WKH +,9 WUHDWPHQW FHQWUH )LJXUH & VKRZV GHDWK UDWHV RI DOO SDWLHQWV ZLWK $,'6 IRU GLIIHUHQW \HDUV

7KH GRFXPHQWDWLRQ RI GHDWK LV SDUWLDOO\ LQFRPSOHWH LQ WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP H J FRQVLGHUDEOH SURSRUWLRQ RI SDWLHQWV ZLWKRXW IROORZ XS VLQFH DUH QRW GRFXPHQWHG GHDG EXW SUHVXPHG GHDG VHH FKDSWHU

0257$/,7< 2) 3$7,(176 :,7+ $,'6 6,1&(

12. BENEFITS OF ANTIRETROVIRAL THERAPY

Risk factors for mortality after the diagnosis AIDS Linz, Innsbruck Variable Demographic characteristics $JH <42 years Â&#x2022;42 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Hetero +,9 FHQWUH Linz Innsbruck Stage of disease &' QDGLU Missing 50 cells/Î¼l 50-199 cells/Î¼l Â&#x2022;200 cells/Î¼l Year of AIDS diagnosis 1986 - 1990 1991 - 1994 1995 - 1997 1998 - 2001 2002 - 2009

Frequencies N= 438 / 831 (52,71%)

(57,44%) (47,63%)

247 / 430 191 / 401

(49,09%) (66,95%) (64,52%) (32,41%)

/ 165 / 351 / 62 / 253

81 235 40 82

(55,46%) (47,06%)

310 / 559 128 / 272

(74,94%) (30,53%)

311 / 415 127 / 416

/ / / /

120 164 70 57 27

/ 29 (100,00%) / 413 (61,02%) / 293 (42,66%) / 96 (33,33%)

29 252 125 32

125 194 149 166

/ 197

(96,00%) (84,54%) (46,98%) (34,34%) (13,71%)

Model 1 (N = 831) Multivariate regression* HR (95% CI) p-value

Univariate regression HR (95% CI) p-value

4,46 3,61 â&#x20AC;&#x201C;5,52 1 1,25 1,02 â&#x20AC;&#x201C;1,54 1 1,71 1,25 â&#x20AC;&#x201C;2,32 2,33 1,81 â&#x20AC;&#x201C;3,00 2,61 1,79 â&#x20AC;&#x201C;3,80 1 1,38 1,15 â&#x20AC;&#x201C;1,67 1

1,95 1,35 â&#x20AC;&#x201C;2,81 1,29 0,88 â&#x20AC;&#x201C;1,91 1 9,93 6,59 2,32 1,63

6,54 4,38 1,48 1,03

â&#x20AC;&#x201C;15,09 â&#x20AC;&#x201C;9,92 â&#x20AC;&#x201C;3,63 â&#x20AC;&#x201C;2,58

<0,001

3,18 2,52 â&#x20AC;&#x201C;4,02 1

<0,001

0,033

<0,001 <0,001 <0,001

1,54 1,08 â&#x20AC;&#x201C;2,19 1,40 1,05 â&#x20AC;&#x201C;1,86 1,38 0,92 â&#x20AC;&#x201C;2,08 1

0,017 0,021 0,116

<0,001

<0,001 0,192

<0,001 <0,001 <0,001 0,039

4,66 4,46 2,08 1,62 1

2,95 2,89 1,32 1,01

â&#x20AC;&#x201C;7,36 â&#x20AC;&#x201C;6,88 â&#x20AC;&#x201C;3,29 â&#x20AC;&#x201C;2,58

<0,001 <0,001 0,002 0,044

* adjusted for the variables: gender, HIV centre, CD4 nadir 97

Causes of death

30%

25%

20%

15%

10%

30%

25%

20%

15%

10%

35%

In M S O A H N U N A ui cc nk B on on ID th yo to V ci er S xi id no -A -A ca /H de -d ca en ca ID ID rd w C ef tio V t/v n S S us ia in li n de de io in es n le g fin fin fa n di rc td in in se tio g g ea as tu in n/ th es fe m st ct or ro io s k ns e

40%

Causes of death (men)

TOTAL

532

57 85 50 43 7 51 5 49 2 25 7 3 1 3 9 6 5 15 21 36 21 31

Number

100,00

10,71 15,98 9,40 8,08 1,32 9,59 0,94 9,21 0,38 4,70 1,32 0,56 0,19 0,56 1,69 1,13 0,94 2,82 3,95 6,77 3,95 5,83

A ID S

H N N M O A S In U ui on B on cc nk th yo to V ci er id xi no -A -A ca /H -d de ca en ca ID ID C rd w ef tio V t/v n S S us ia in li de de n io in es n le g fin fin fa n di rc in in td se tio g g ea as in tu n/ th es fe m st ct or ro io s k ns e

Causes of death (women)

AIDS not s pec ified AIDS defining infec tion AIDS defining m alignanc y Bac terial infec tion, non AIDS defining Other infec tion, non AIDS defining Hepatitis C Hepatitis B Non AIDS defining tum ours Panc reatitis Myocardial infarction or other ischemic heart disease Stroke Gas tro-intes tinal haem orrhage Pulm onary hypertens ion Lung em bolus Chronic obs truc tive lung dis eas e Liver failure (other than HBV, HCV, lactic acidosis) Renal failure Ac c ident/ violent death Suic ide Subs tanc e abus e/ intoxic ation Other c aus es Unkown

12.2.1

0257$/,7< ,1 &20%,1$7,21 $57 (5$ 6,1&(

Death rate

100

Age (median) Last CD4 cell count (median) Mortality rate per 100 person-years All HIV-associated HBV/HCV-associated Non-AIDS tumours Myocardial infarction Gender Male Female Mode of transmission MSM IDU Heterosexual contacts Age (tertiles) <33 34-45 >45 CD4 nadir <50 CD4 nadir <200 Area of residence Non-metropolitan area Metropolitan city 2,32 1,03 0,30 0,17 0,10 2,48 1,96 1,23 5,57 1,35 4,63 2,57 1,60 5,81 3,86 2,11 2,63

2,83 1,51 0,34 0,11 0,19

3,41 2,26

1,75 5,41 1,25

9,45 4,25 1,22 7,80 6,18

3,33 2,72

Death rates

2001-2004 40,7 206

1997-2000 39,8 145

2,05 2,78

1,87 2,26 2,66 5,07 3,68

1,85 4,54 1,57

2,67 1,62

2,34 1,01 0,19 0,36 0,09

2005-2008 45,8 188

Characteristics of deceased patients and death rates in the cART era

$.+ 9LHQQD /LQ] ,QQVEUXFN *UD] VLQFH GHDWKV LQ SHUVRQ \HDUV SHU SHUVRQ \HDUV VLQFH

12.2.2

101

102

12.3.1

,W KDV WR EH QRWHG WKDW WKH SRLQW SUHYDOHQFH RI KHSDWLWLV & LQ DPRXQWHG WR LQ WR DQG LQ WR

2003

2004

2005

2006

2007 Year of the initial therapy

2008

2009

Patients initiating ART (N) <200 and < 6 months <200 and > 6 months 200-350 and < 6 months 200-350 and > 6 months >350 No CD4 count before ART

Initial therapy 164 43 22 18 21 29 31

159 (26,2%) 37 (13,4%) 27 (11,0%) 13 (12,8%) 32 (17,7%) 21 (18,9%) 29

2003

(23,3%) (17,0%) (8,2%) (20,1%) (13,2%) (18,2%)

2004 183 43 36 13 42 16 33

191 (23,5%) 49 (19,7%) 38 (7,1%) 21 (23,0%) 47 (8,7%) 30 (18,0%) 6

2005

(25,7%) (19,9%) (11,0%) (24,6%) (15,7%) (3,1%)

2006 255 56 55 25 60 47 12

(22,0%) (21,6%) (9,8%) (23,5%) (18,4%) (4,7%)

2007 255 47 46 41 72 40 9

285 (18,4%) 54 (18,0%) 38 (16,1%) 29 (28,2%) 80 (15,7%) 67 (3,5%) 16

2008

(18,9%) (13,3%) (10,2%) (28,1%) (23,5%) (5,6%)

2009

103

1491 329 (22,1%) 262 (17,6%) 160 (10,7%) 354 (23,7%) 250 (16,8%) 136 (9,1%)

Total

CD4 count categories and time elapsed between HIV diagnosis and initiation of ART

100

125

150

175

200

225

250

275

300

325

350

375

CD4 cell counts at initiation of ART

&' &(// &28176

HIV-associated versus hepatitis B/C-associated causes of death (all patients)

Median CD4 cell count before ART

104

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

HETERO

IDU

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

MSM

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

TOTAL

2003

2004

2006

2007

2008

2009

>6 months after HIV diagnosis

Year of ART initiation

2005

<6 months after HIV diagnosis

2003

12.3.2.1 Overview

<HOORZ EDUV %HJLQQLQJ RI WKHUDS\ ZLWKLQ PRQWKV DIWHU +,9 GLDJQRVLV %OXH EDUV %HJLQQLQJ RI WKHUDS\ PRUH WKDQ PRQWKV DIWHU +,9 GLDJQRVLV

CD4 cell counts (nadir and most recent)

12.3.2

CD4 cell count <200 at initiation of ART

105

106

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

Zero >=1

Number of treatment interruptions

100

200

300

400

500

600

700

800

900

1000

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

<100 100-200 >200

CD4 count before ART

107

%HORZ RQO\ SDWLHQWV ZLWKRXW D WUHDWPHQW LQWHUUXSWLRQ VHH EOXH FXUYHV LQ DERYH PHQWLRQHG FKDUW DUH VKRZQ GXH WR WKHLU ODVW &' FRXQW EHIRUH $57

100

200

300

400

500

600

700

800

900

1000

7KH DQDO\VLV LQFOXGHV RQO\ SDWLHQWV ZKR LQLWLDWHG F$57 DIWHU -DQXDU\

12.3.2.2 Most recent CD cell count by duration of therapy

Last CD4 cell count (cells/Î¼l)

(44,57%) (41,10%)

1343 / 3013 335 / 815

335 / 815 824 / 1889 519 / 1124

7HQRIRYLU XVH HYHU No ART use Yes No

0,077

<0,001 <0,001 <0,001 <0,001

1,15 0,98 - 1,35 1

- 2,03 - 2,91 - 2,60 - 2,36

0,81 0,68 - 0,98 0,90 0,78 - 1,05 1 0,027 0,173

<0,001

0,69 0,59 - 0,80 1

(41,10%) (43,62%) (46,17%)

<0,001

0,67 0,56 - 0,81

0,916 0,004

0,99 0,83 - 1,19 1,24 1,07 - 1,44 1

(41,69%) (50,96%)

<0,001 <0,001

0,63 0,53 - 0,76 0,60 0,52 - 0,70 1

(41,10%)

(41,10%) (46,65%) (41,34%)

(41,10%) (39,81%) (52,41%)

<0,001 <0,001

0,24 0,20 - 0,30 0,43 0,37 - 0,50 1

1,31 1,96 1,54 1,45

<0,001

0,72 0,61 - 0,86 1

1,63 2,39 2,00 1,85 1

<0,001

1,64 1,43 -1,87 1

0,843 <0,001 0,766

0,059

0,87 0,76 - 1,01 1

0,98 0,85 - 1,14 0,54 0,45 - 0,64 0,96 0,74 - 1,25 1

0,003

0,82 0,72 - 0,93 1

Univariate regression p-value OR (95% CI)

0,69 3,03 1,80 1,92

108

–1,58 –5,37 –3,28 –3,33

0,75 0,62 –0,90 1

2,14 1,76 –2,60 1

0,52 0,41 –0,65 1

1,05 4,03 2,43 2,53 1

0,12 0,09 –0,15 0,24 0,20 –0,29 1

1,03 0,85 –1,24 0,68 0,53 –0,87 1,05 0,78 –1,42 1

0,002

<0,001

0,831 <0,001 <0,001 <0,001

<0,001 <0,001

0,782 0,002 0,728

Model 1 (N = 3828) Multivariate regression* p-value OR (95% CI)

* adjusted for the variables: age, gender, area of residence, hepatitis C, Tenofovir use ever

335 / 815 865 / 2075 478 / 938

335 / 815 856 / 1835 487 / 1178

335 / 815 746 / 1874 597 / 1139

(41,10%) (50,54%) (46,13%) (44,18%) (29,98%)

(24,08%) (35,67%) (56,49%)

170 / 706 438 / 1228 1070 / 1894

815 1490 388 498 637

(37,27%) (45,18%)

243 / 652 1435 / 3176

/ / / / /

(48,34%) (36,38%)

1153 / 2385 525 / 1443

335 753 179 220 191

(46,65%) (32,31%) (46,04%) (47,03%)

1269 780 265 1514

/ / / /

(42,87%) (46,22%)

1170 / 2729 508 / 1099

592 252 122 712

(41,42%) (46,24%)

792 / 1912 886 / 1916

Frequencies N= 1678 / 3828 (43,83%)

7KHUDS\ VZLWFKHV LQ VW \HDU No ART use Zero 1

No ART use Zero 1

1XPE HU RI WKHUDS\ UHJLPHQV No ART use <4 4 7UHDWPHQW LQWHUUXSWLRQV

t 90 60-89 30-59 <30

No ART use

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHD RI UHVLGHQFH Non-metropolitan Metropolitan Comorbidity +HSDWLWLV & HCV RNA positive HCV RNA negative Stage of disease &' QDGLU 50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57 XVH HYHU Yes No 'XUDWLRQ RI WUHDWPHQW PRQWKV

Variable Demographic characteristics $JH <42.5 years t 42.5 years *HQGHU Male Female

All centres

12.3.2.3 CD4 cells >500/μl

0,77 0,59 –0,99 1

0,66 0,48 –0,90 1

4,78 3,41 –6,69 2,27 1,62 –3,19 2,51 1,86 –3,38 1

0,15 0,11 –0,21 0,28 0,22 –0,35 1

1,10 0,84 –1,44 0,58 0,39 –0,86 1,54 0,99 –2,38 1

0,040

0,008

<0,001 <0,001 <0,001

<0,001 <0,001

0,497 0,006 0,054

Model 1 (N = 1835) Multivariate regression* p-value OR (95% CI)

* adjusted for the variables: age, gender, area of residence, hepatitis C, Tenofovir use ever

7HQRIRYLU XVH HYHU Yes No

<4 4 7KHUDS\ VZLWFKHV LQ VW \HDU Zero 1

Comorbidity +HSDWLWLV & HCV RNA positive HCV RNA negative Stage of disease &' QDGLU 50 cells/μl 50-199 cells/μl t 200 cells/μl ART $57 XVH HYHU Yes No 'XUDWLRQ RI WUHDWPHQW PRQWKV

t 90 60-89 30-59 <30 1XPE HU RI WKHUDS\ UHJLPHQV

Variable Demographic characteristics $JH <43 years t 43 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual

All centres

12.3.2.4 CD4 cells >500/μl: patients without treatment interruptions only

109

(6,47%) (6,25%)

(6,26%) (6,53%)

69 / 1066 53 / 848

70 / 1118 52 / 796

20 / 151 (13,25%) 102 / 1763 (5,79%)

19 / 135 (14,07%) 103 / 1779 (5,79%)

Cumulative resistances 157, 1157, Yes No

157 , 1157, 3, Yes No

2,67 1,58 â&#x20AC;&#x201C;4,50 1 <0,001

<0,001

0,811

0,96 0,66 â&#x20AC;&#x201C;1,38 1

2,49 1,49 â&#x20AC;&#x201C;4,15 1

0,843

1,04 0,72 â&#x20AC;&#x201C;1,50 1

0,516

2,53 1,39 â&#x20AC;&#x201C;4,60 1

1,96 1,16 â&#x20AC;&#x201C;3,30 1

0,52 0,29 â&#x20AC;&#x201C;0,96

3,12 2,08 â&#x20AC;&#x201C;4,68 1

0,56 0,32 â&#x20AC;&#x201C;0,99 1,94 1,19 â&#x20AC;&#x201C;3,16 0,90 0,36 â&#x20AC;&#x201C;2,27 1

0,002

0,011

0,035

<0,001

0,048 0,008 0,822

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

110

* adjusted for the variables: age, gender, area of residence, nationality, treatment switches and treatment interruptions

(6,56%)

100 / 1525

0,85 0,53 â&#x20AC;&#x201C;1,37 1

70 / 655 (10,69%) 52 / 1259 (4,13%)

(5,66%)

<0,001

2,78 1,91 â&#x20AC;&#x201C;4,03 1

(8,47%) (6,14%)

22 / 389

0,217

1,41 0,82 â&#x20AC;&#x201C;2,44 1

0,107

16 / 189 106 / 1725

0,73 0,50 â&#x20AC;&#x201C;1,07 1

0,191 <0,001 0,875

(5,77%) (7,72%)

0,73 0,45 â&#x20AC;&#x201C;1,17 2,48 1,59 â&#x20AC;&#x201C;3,85 0,93 0,39 â&#x20AC;&#x201C;2,23 1

76 / 1318 46 / 596

640 (4,22%) 306 (13,07%) 112 (5,36%) 856 (5,72%)

0,538

1,14 0,76 â&#x20AC;&#x201C;1,70 1

(6,61%) (5,86%)

87 / 1317 35 / 597

/ / / /

0,062

1,42 0,98 â&#x20AC;&#x201C;2,06 1

(7,42%) (5,33%)

71 / 957 51 / 957

27 40 6 49

Univariate regression OR (95% CI) p-value

Frequencies N= 122 / 1914 (6,37%)

After 1.1.1997 1XPEHU RI WKHUDS\ UHJLPHQV <4 t4 7UHDWPHQW VZLWFKHV LQ WKH ILUVW \HDU None t1

$57 LQLWLDWLRQ Before 1.1.1997

Variable Demographic characteristics $JH <45 years t45 years *HQGHU Male Female

All centres

12.3.2.5 Risk factors for a CD4 cell count <200/Îźl on ART

Increase of CD4 cells during ART

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

Zero >=1

Number of therapy interruptions

100

200

300

400

500

600

700

1-2.5

2.5-5 5-7.5 Duration of cART (in years)

> 7.5

<100 100-200 >200

CD4 count before ART

111

%HORZ RQO\ SDWLHQWV ZLWKRXW D WUHDWPHQW LQWHUUXSWLRQ VHH EOXH FXUYHV LQ DERYH PHQWLRQHG FKDUW DUH VKRZQ EHORZ GXH WR WKHLU ODVW &' FRXQW EHIRUH $57

100

200

300

400

500

600

700

7KH DQDO\VLV LQFOXGHV RQO\ SDWLHQWV ZKR LQLWLDWHG F$57 DIWHU -DQXDU\

12.3.3

Increase of CD4 cells (cells/Îźl) Increase of CD4 cells (cells/Îźl)

112

RI WKH FXUUHQW FRKRUWÂ¶V SDWLHQWV RI KDYH D FXUUHQW +,9 51$ EHORZ FRSLHV PO

ART initiation

96 997 998 999 000 001 002 003 004 005 006 007 1 1 2 2 1 19 2 2 2 2 2 2

Strategy A Strategy B

Year of initial antiretroviral therapy 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Lampe F et al. 14,8 20,6 19,8 18,7 18,4 17,7 14,6 27,8 33,2 26,2 24,6 26,9 25,3 21,2 22,6 17,9 20,4 22,3 20,2 AHIVCOS

% of patients without HIV RNA measurement 1 year after the ART initiation

SOHWH IROORZ XS 7KH YDOXHV IRU DQG IURP /DPSH HW DO DUH VKRZQ LQ WKH JUDSK SS

113

&RPSDUHG WR RWKHU FRKRUWV /DPSH ) HW DO $UFK ,QWHUQ 0HG WKH YLURORJLF UHVSRQVH \HDU DIWHU $57 LQLWLDWLRQ LV VOLJKWO\ ZRUVH 7KLV LV PRVWO\ GXH WR WKH PLVVLQJ +,9 51$ PHDVXUHPHQWV LQFRP-

100 90 80 70 60 50 40 30 20 10 0

Strategy B 1 LQFOXGHV DOO SDWLHQWV RQ DQWLUHWURYLUDO WKHUDS\ ZKR KDG DW OHDVW RQH PHDVXUHPHQW RI WKHLU YLUDO ORDG EHWZHHQ PRQWK DQG DIWHU WKHUDS\ ZDV VWDUWHG

Strategy A 1 LQFOXGHV DOO SDWLHQWV RQ DQWLUHWURYLUDO WKHUDS\ SDWLHQWV ZKR KDG QR PHDVXUHPHQW RI YLUDO ORDG +,9 51$ EHWZHHQ PRQWK DQG DIWHU WKHUDS\ ZDV VWDUWHG DUH FODVVLÂ¿HG DV YLURORJLF QRQ UHVSRQGHUV Â&#x2022; FRSLHV PO

Last HIV RNA in the current cohort

12.4.1

Virologic response 1 year after ART initiation: 1996 to 2007

12.4.2

+,9 51$ 9,5$/ /2$'

% HIV RNA Â&#x2022;400 copies/ml

Last HIV RNA of patients on ART

114

Last HIV RNA in copies/ml

10%

Over 9999

20%

10009999

30%

50%

40%

33 34-45 Over 45

40%

50%

Up to 50 51-399 400-999

70%

60%

80%

60%

90%

Agegroup

100%

10009999

Last HIV RNA in copies/ml

Up to 50 51-399 400-999

Over 9999

Male Female

Gender

Current cohort + ART, measurement of viral load at least 75 days after ART initiation

12.4.3.1 Last HIV RNA of patients on ART strati ed by age and gender

HIV RNA <200 copies/ml HIV RNA <400 copies/ml HIV RNA 50 copies/ml HIV RNA <400 copies/ml, at least 75 days betw. ART initiation + HIV RNA measurement HIV RNA 50 copies/ml, at least 75 days betw. ART initiation + HIV RNA measurement

3 4 3 2 2 4 8 0 5 9 5 9 6 8 7 7 6 /0 1/0 /0 /0 7/0 /0 /0 7/0 /0 /0 7/0 /0 /0 /0 1/1 /0 1/0 07 01 0 0 07 01 0 0 01 01 01 0 07 07 07 01 0

100

12.4.3

% of patients

12.4.3.3 Last HIV RNA of patients on ART according to transmission risk

12.4.3.2 Last HIV RNA of patients on ART at different points in time

115

(6,88%) (3,25%)

(3,82%) (3,49%)

13 / 189 56 / 1725

25 / 655 44 / 1259

(8,15%) (3,26%)

(3,04%) (4,40%)

34 / 1118 35 / 796

11 / 135 58 / 1779

(3,32%) (4,19%)

43 / 1294 26 / 620

(7,95%) (3,23%)

(4,03%) (3,07%)

43 / 1066 26 / 848

12 / 151 57 / 1763

(2,31%) (3,93%)

9 / 389 60 / 1525

(6,09%) (3,63%) (2,27%)

(2,88%) (5,20%)

38 / 1318 31 / 596

24 / 394 28 / 772 17 / 748

(2,34%) (7,19%) (3,57%) (3,27%)

640 306 112 856

/ / / /

0,013

0,720

2,20 1,18 â&#x20AC;&#x201C;4,10 1

1,10 0,66 â&#x20AC;&#x201C;1,81 1

0,005

0,119

0,68 0,42 â&#x20AC;&#x201C;1,10 1

2,63 1,35 â&#x20AC;&#x201C;5,14 1

0,340

0,79 0,48 â&#x20AC;&#x201C;1,29 1

0,004

0,261

1,33 0,81 â&#x20AC;&#x201C;2,18 1

2,58 1,35 â&#x20AC;&#x201C;4,93 1

0,130

0,58 0,28 â&#x20AC;&#x201C;1,18 1

0,002 0,123

0,013

0,54 0,33 â&#x20AC;&#x201C;0,88 1

2,79 1,48 â&#x20AC;&#x201C;5,26 1,62 0,88 â&#x20AC;&#x201C;2,98 1

0,290 0,005 0,867

0,71 0,38 â&#x20AC;&#x201C;1,34 2,29 1,29 â&#x20AC;&#x201C;4,07 1,10 0,38 â&#x20AC;&#x201C;3,18 1

3,43 1,59 â&#x20AC;&#x201C;7,40 1

2,86 1,46 â&#x20AC;&#x201C;5,62 1,53 0,81 â&#x20AC;&#x201C;2,87

0,86 0,39 â&#x20AC;&#x201C;1,90 2,40 1,25 â&#x20AC;&#x201C;4,62 1,48 0,47 â&#x20AC;&#x201C;4,66 1

0,238

0,74 0,45 â&#x20AC;&#x201C;1,22 1

(3,26%) (4,36%)

43 / 1317 26 / 597

15 22 4 28

2,31 1,28 â&#x20AC;&#x201C;4,17 1

<0,001

2,94 1,70 â&#x20AC;&#x201C;5,06 1

(5,33%) (1,88%)

51 / 957 18 / 957

116

0,002

0,002 0,189

0,718 0,009 0,501

0,005

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

Univariate regression OR (95% CI) p-value

Frequencies N= (3,61%) 69 / 1914

400 copies/ml on ART

* adjusted for the variables: gender, area of residence, nationality, ART initiation, number of therapy regimens, treatment interruptions, treatment switches

Cumulative resistances 157, 1157, Yes No 157 , 1157, 3, Yes No

ART $57 LQLWLDWLRQ Before 1.1.1997 After 1.1.1997 1XPE HU RI WKHUDS\ UHJLPHQV <4 t4 7UHDWPHQW LQWHUUXSWLRQV None t1 7UHDWPHQW VZLWFKHV LQ WKH ILUVW \HDU None t1

<50 copies/Îźl 50-199 copies/Îźl t200 copies/Îźl

Variable Demographic characteristics $JH <45 years t45 years *HQGHU Male Female

All centres

12.4.4.1 Risk factors for HIV RNA

7KH DQDO\VHV LQ FKDSWHU LQFOXGH DOO SDWLHQWV LQ WKH FXUUHQW FRKRUW ZKR KDYH EHHQ RQ $57 IRU DW OHDVW GD\V EHIRUH WKH PHDVXUHPHQW RI WKH YLUDO ORDG

12.4.4 Risk factors for viral replication

(16,40%) (9,80%)

(10,53%) (10,41%) (12,69%) (11,01%) (8,69%)

31 / 189 169 / 1725

69 / 655 131 / 1259 50 / 394 85 / 772 65 / 748

(8,77%) (12,81%)

98 / 1118 102 / 796

24 / 151 176 / 1763 20 / 135 180 / 1779

Cumulative resistances 157, 1157, Yes No 157 , 1157, 3, Yes No

1,54 0,94 â&#x20AC;&#x201C;2,55 1

1,70 1,07 â&#x20AC;&#x201C;2,71 1

0,65 0,49 â&#x20AC;&#x201C;0,88 1

1,14 0,84 â&#x20AC;&#x201C;1,53 1

0,088

0,024

0,005

0,399

0,904

0,034 0,130

1,53 1,03 â&#x20AC;&#x201C;2,26 1,30 0,93 â&#x20AC;&#x201C;1,83 1

0,98 0,68 â&#x20AC;&#x201C;1,41 1

0,930

0,005

0,018

1,01 0,75 â&#x20AC;&#x201C;1,38 1

1,81 1,19 â&#x20AC;&#x201C;2,74 1

0,69 0,51 â&#x20AC;&#x201C;0,94 1

0,755 0,011 0,734

0,220

0,82 0,61 â&#x20AC;&#x201C;1,12 1 0,95 0,67 â&#x20AC;&#x201C;1,34 1,65 1,12 â&#x20AC;&#x201C;2,43 1,12 0,59 â&#x20AC;&#x201C;2,12 1

<0,001

2,14 1,57 â&#x20AC;&#x201C;2,92 1

Univariate regression OR (95% CI) p-value

0,59 0,43 â&#x20AC;&#x201C;0,81 1

1,55 1,03 â&#x20AC;&#x201C;2,35 1

1,54 1,02 â&#x20AC;&#x201C;2,33 1,29 0,91 â&#x20AC;&#x201C;1,84 1

1,66 1,03 â&#x20AC;&#x201C;2,65 1

1,11 0,71 â&#x20AC;&#x201C;1,73 1,63 1,07 â&#x20AC;&#x201C;2,50 1,30 0,65 â&#x20AC;&#x201C;2,59 1

1,95 1,39 â&#x20AC;&#x201C;2,72 1

0,001

0,036

0,040 0,159

0,036

0,641 0,024 0,455

<0,001

Model 1 (N = 1914) Multivariate regression* OR (95% CI) p-value

117

* adjusted for the variables: gender, area of residence, ART initiation, resistance against NRTI+NNRTI and treatment interruptions

(14,81%) (10,12%)

(15,89%) (9,98%)

(10,98%) (9,79%)

117 / 1066 83 / 848

(10,28%) (10,49%)

(2,43%) (5,20%)

32 / 1318 31 / 596

40 / 389 160 / 1525

(9,22%) (15,03%) (10,71%) (9,70%)

640 306 112 856

/ / / /

(9,87%) (11,73%)

130 / 1317 70 / 597 59 46 12 83

(13,90%) (7,00%)

133 / 957 67 / 957

Frequencies N= 200 / 1914 (10,45%)

1XPEHU RI WKHUDS\ UHJLPHQV <4 t4 7UHDWPHQW VZLWFKHV LQ WKH ILUVW \HDU None t1

Variable Demographic characteristics $JH <45 years t 45 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHD RI UHVLGHQFH Non-metropolitan Metropolitan 1DWLRQDOLW\ High prevalence countries Low prevalence countries Stage of disease $,'6 Yes No &' QDGLU <50 copies/Îźl 50-199 copies/Îźl t 200 copies/Îźl ART $57 LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

All centres

12.4.4.2 Risk factors for HIV RNA >50 copies/ml on ART

ISKS OF ROVIRAL HERAPY

120

M41 A62 K65 D67 T69 K70 L74 V75 F77 Y115 F116 Q151 M184 L210 T215 K219

NRTI

L V R N ins R, E V I L F Y M V, I W Y, F Q, E

V90 A98 L100 K101 K103 V106 V108 E138 V179 Y181 Y188 G190 P225 M230

F, T I, V H, C S

M, I

E, P

NNRTI

I G I H, N A, I A D, C, L, A, H L

Reverse transcriptase L10 V11 I13 G16 K20 L24 D30 V32 L33 E34 E35 M36 K43 M46 I47 G48 I50 F53 I54 Q58 D60 I62 L63 I64 H69 A71 G73 T74 L76 V77 V82 N83 I84 I85 N88 L89 L90 I93

F, R, I, V, C I V E R, M, I, T, V I N I I, F, V Q G I, L, V T I, L V, A V V, L L, Y V, M, L, T, S, A E E V P L, M, V K V, I, T, L S, T, C, A P V I A, T, F, S, I, L D V V D, S V M L, M

Protease

The following codons and amino acids have been classified as resistance (IAS):

7KH UHVLVWDQFH PXWDWLRQV KDYH EHHQ FODVVL¿HG DFFRUGLQJ WR WKH ³8SGDWH RI WKH 'UXJ 5HVLVWDQFH 0XWDWLRQV LQ +,9 'HFHPEHU ´ IURP WKH ,QWHUQDWLRQDO $,'6 6RFLHW\ 86$ KWWS LDVXVD RUJ UHVLVWDQFHBPXWDWLRQV PXWDWLRQVB¿JXUHV SGI

Frequency of NRTI-associated resistance mutations

0 1 0 1

Codon 77 Codon 115 Codon 116 Codon 151

(0,3%)

(0,0%)

(0,3%)

(0,0%)

(0,3%)

(3,8%)

(6,2%)

(4,1%)

Codon 75

(1,1%)

Codon 219

Codon 74

(3,8%)

Codon 70

(0,0%)

Codon 215

Codon 69

(6,5%)

Codon 67

(0,0%)

Codon 210

Codon 65

(0,0%)

37 (10,0%)

Codon 62

(5,4%)

Codon 184

51 (13,8%)

N = 370

Deceased since 1997, NRTI use

Codon 41

Resistance to NRTI

All centers

135

195

123

122

(2,4%)

(6,4%)

(3,3%)

(9,2%)

(0,1%)

(0,2%)

(1,1%)

(4,1%)

(0,1%)

(5,8%)

(0,7%)

(0,8%)

(5,7%)

292 (13,7%)

N = 2124

Current cohort and NRTI use ever

121

7KH WDEOH VKRZV WKH QXPEHUV RI SDWLHQWV ZLWK 157, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV DPRQJ DOO SDWLHQWV ZKR KDYH HYHU EHHQ WUHDWHG ZLWK 1XFOHRVLGH 5HYHUVH 7UDQVFULSWDVH ,QKLELWRUV ³157,´

13.2.1.1 Overview

13.2.1

³&XPXODWLYH UHVLVWDQFH´ LQFOXGHV DQ\ PXWDWLRQ HYHU IRXQG LQ D SDUWLFXODU SDWLHQW

'(),1,7,21 2) 5(6,67$1&( 81'(5 $57

Basics: 7KH UDWH RI UHVLVWDQFH GHYHORSPHQW GXULQJ DQWLUHWURYLUDO WKHUDS\ ³SHUFHQW ZLWK UHVLVWDQFH´ FRUUHVSRQGV WR WKH QXPEHU RI SDWLHQWV ZLWK UHVLVWDQFH PXWDWLRQV LQ UHODWLRQ WR WKH QXPEHU RI SDWLHQWV RQ $57 VHH DOVR FKDSWHU 0RVW JHQRW\SLF UHVLVWDQFH WHVWV DUH SHUIRUPHG DW WKH ,QVWLWXWH RI 9LURORJ\ DW WKH 0HGLFDO 8QLYHUVLW\ 9LHQQD

)5(48(1&< 2) 5(6,67$1&(

13. RISKS OF ANTIRETROVIRAL THERAPY

(0,68%) (0,55%)

(1,33%) (0,25%)

(0,00%) (1,37%) (0,70%) (0,17%)

13 / 1921 6 / 1097

14 / 1050 5 / 1968

0 9 8 2

(0,71%) (0,57%)

(0,89%) (0,18%)

(0,51%) (0,66%)

9 / 1264 10 / 1754

17 / 1900 2 / 1118

3 / 585 16 / 2433

/ 24 / 656 / 1135 / 1203

(0,41%) (0,83%) (0,00%) (0,81%)

/ / / /

(0,67%)

978 599 210 1231

4 5 0 10

6 / 892

0,627

0,031

0,692

1,25 0,51 –3,09 1

5,04 1,16 –21,85 1

0,78 0,23 –2,68 1

0,007 0,067

0,001

5,31 1,91 –14,77 1

8,35 1,80 –38,78 4,26 0,90 –20,12 1

0,665

0,245 0,960 -

1,24 0,47 –3,27 1

0,50 0,16 –1,60 1,03 0,35 –3,02 1

0,846

0,91 0,34 –2,40

(0,61%)

5,32 1,18 – 23,99 1

7,55 1,58 –35,99 3,97 0,83 –19,03 1

122

0,030

0,011 0,085

Model 1 (N = 3018) Multivariate regression* OR (95% CI) p-value

* adjusted for the variables: age, gender, mode of transmission, area of residence, Abacavir use ever, ART initiation

Yes No 7HQRIRYLU XVH HYHU Yes No $57 LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

$EDFDYLU XVH HYHU

<50 copies/μl 50-199 copies/μl t200 copies/μl ART

Missing

0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual $UHD RI UHVLGHQFH Non-metropolitan Metropolitan Stage of disease $,'6 Yes No &' QDGLU

Female

0,492

0,73 0,29 –1,81 1

Univariate regression OR (95% CI) p-value

(0,53%) (0,73%)

Frequencies N= 19 / 3018 (0,63%)

Variable Demographic characteristics $JH <44 years 8 / 1509 11 / 1509 t44 years *HQGHU Male 13 / 2126

All centres

5HFUXLWPHQW IRU WKLV DQDO\VLV KDV EHHQ LQ DJUHHPHQW WR HQWU\ FULWHULD RI &2+(5(

13.2.1.2 Risk factors for developing a resistance mutation on codon 65 (K65R) of the RT (patients with past or present NRTI use)

Frequency of NNRTI-associated resistance mutations

0 0

Codon 138 Codon 179

1 0

Codon 230

5 Codon 225

Codon 190

Codon 108

Codon 188

Codon 106

Codon 103

Codon 181

Codon 100 Codon 101

(0,0%)

(0,5%)

(2,3%)

(0,5%)

(8,1%)

(0,0%)

(0,9%)

(0,5%)

(6,3%)

(2,7%)

(0,0%)

(2,7%)

(0,0%)

32 (14,4%)

N = 222

(0,1%)

(0,4%)

(2,9%)

(0,7%)

(4,1%)

(0,3%)

(0,0%)

(1,1%)

(0,9%)

(7,1%)

(1,4%)

(0,6%)

(1,0%)

(0,4%)

173 (12,3%)

N = 1404

Deceased since Current cohort 1997, NNRTI and NNRTI use use ever

Codon 98

Codon 90

Resistance to NNRTI

All centers

123

7KH WDEOH VKRZV WKH QXPEHUV RI 1157, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV DPRQJ SDWLHQWV ZKR KDYH HYHU EHHQ WUHDWHG ZLWK 1RQ 1XFOHRVLGH 5HYHUVH 7UDQVFULSWDVH ,QKLELWRUV ³1157,´

13.2.2

Frequency of PI-associated resistance mutations

124

50 (18,2%)

Codon 50

Codon 53

Codon 54

Codon 63

Codon 71

Codon 73

Codon 77

Codon 82

Codon 84

Codon 88

Codon 90

(3,6%)

(0,7%)

(2,5%)

(2,9%)

(4,7%)

(0,4%)

(8,0%)

(4,7%)

(0,0%)

(0,4%)

(0,7%)

(3,6%)

Codon 48

(1,5%)

Codon 33

(0,7%)

Codon 47

Codon 32

(0,7%)

Codon 30

(0,7%)

Codon 46

Codon 24

(5,1%)

36 (13,1%)

Codon 20

(6,9%)

Codon 36

65 (23,6%)

N = 275

(2,0%)

(0,7%)

(1,1%)

(0,7%)

(4,1%)

(8,5%)

(2,3%)

(0,8%)

(0,1%)

(0,4%)

(0,5%)

(3,8%)

(3,1%)

(1,2%)

(2,5%)

(8,6%)

132 39

(0,9%)

(6,6%)

101

272 (17,7%)

202 (13,2%)

131

442 (28,8%)

N = 1533

Deceased since Current cohort 1997, PI use and PI use ever

Codon 10

Resistance to PI

All centers

7KH WDEOH VKRZV WKH QXPEHUV RI WKH 3, DVVRFLDWHG UHVLVWDQFH PXWDWLRQV DPRQJ SDWLHQWV ZKR KDYH HYHU EHHQ WUHDWHG ZLWK 3URWHDVH ,QKLELWRUV ³3,´

13.2.3

13.2.4

(7,3%)

44 24 30 23

NRTI and NNRTI NNRTI and PI 3-class-resistance

(5,1%)

(6,6%)

(5,3%)

(9,7%)

72 (15,9%)

NRTI and PI

NNRTI

52 (11,5%)

NRTI

(1,8%) 82 (18,1%)

90 (19,9%)

N = 453

(3,5%)

(8,6%)

136

164

153

(6,4%)

(7,7%)

(7,2%)

252 (11,8%)

482 (22,6%)

184

292 (13,7%)

525 (24,6%)

599 (28,1%)

N = 2130

Deceased since Current cohort 1997, and ever ART ever ART

"Any" resistance

Wild type

Resistance test available

All centres

Resistance to single or multiple drug classes

125

126

Resistance test available 169 74 54 35 34 42 23 27 18 21 22 11 19 12 5 4 27 28 143 56 44 106 34 119 4 1 566

Wild type 14 8 6 5 3 6 6 4 5 3 3 2 2 2 1 2 4 11 21 7 5 4 15 1 70

Any resistance 155 66 48 30 31 36 17 23 13 18 19 9 17 10 4 2 27 24 132 35 37 101 30 104 3 1 496

NRTI 125 46 23 13 13 18 9 10 2 3 6 2 5 5 4 1 9 12 90 14 18 75 16 46 2 1 284

NNRTI 73 23 16 4 11 13 6 6 1 9 6 1 4 3 2 5 8 53 17 14 29 5 45 2 178

Resistance to NRTI and PI

139 56 45 27 28 34 17 23 13 18 16 9 17 9 3 2 24 24 119 33 36 88 25 100 2 1 454

109 37 20 10 10 16 9 10 2 3 4 2 5 4 3 1 6 12 78 12 17 63 11 42 1 1 244

NRTI and NNRTI 68 21 15 4 6 11 5 6 1 2 4 1 2 2 2 4 8 50 11 11 25 4 35 2 150

NNRTI and PI 67 19 13 4 10 13 6 6 1 9 3 1 4 2 1 3 8 46 15 14 27 4 41 1 159

3-classresistance 62 18 12 4 5 11 5 6 1 2 2 1 2 1 1 2 8 44 9 11 24 3 31 1 133

Resistance according to demographic characteristics

255 133 114 94 103 94 82 85 101 103 128 132 179 186 250 24 88 151 336 141 240 290 85 649 18 17 2039

13.2.5

All centres Number of patients Year of ART initiation Up to 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Federal state Burgenland Carinthia Lower Austria Upper Austria Salzburg Styria Tyrol Vorarlberg Vienna Foreign countries Missing Total

ART initiation after 2000 All centres Number of patients

Resistance test available

Wild type

Any resistance

NRTI

NNRTI

Resistance to NRTI and PI

NRTI and NNRTI

NNRTI and PI

3-classresistance

Year of ART initiation 2001 2002 2003 2004 2005 2006 2007 2008 2009

82 85 101 103 128 132 179 186 250

23 27 18 21 22 11 19 12 5

6 4 5 3 3 2 2 2 1

17 23 13 18 19 9 17 10 4

9 10 2 3 6 2 5 5 4

6 6 1 9 6 1 4 3 2

17 23 13 18 16 9 17 9 3

9 10 2 3 4 2 5 4 3

5 6 1 2 4 1 2 2 2

6 6 1 9 3 1 4 2 1

5 6 1 2 2 1 2 1 1

Residence Central South East West Missing

181 221 528 289 27

36 27 50 44 1

5 3 11 9 0

31 24 39 35 1

15 7 12 11 1

13 5 13 7 -

28 24 37 35 1

13 7 10 11 1

10 3 8 4 -

10 5 11 7 -

8 3 6 4 -

Mode of transmission MSM IDU Others/missing Hetero

428 174 53 591

40 25 3 90

9 4 1 14

31 21 2 76

7 6 1 32

9 7 22

29 20 2 74

6 5 1 30

5 3 17

7 6 20

4 2 15

Gender Male Female

868 378

95 63

13 15

82 48

30 16

26 12

78 47

27 15

18 7

22 11

15 6

Age at time of HIV-test 623 623

127

1246

Total

< 34 years Â&#x2022; 34 years

105 53

18 10

158

87 43

26 20

130

23 15

84 41

23 19

125

14 11

20 13

11 10

243

388

Resistance test after ART

Total

mutations

mutation

mutations

mutation

mutations

100%

62,6%

311

123

188

100%

39,5%

60,5%

10 mutations

11 mutations

0,3%

1,0%

4,1%

8,5%

6,7%

5,9%

6,7%

3,1%

7,7%

18,6%

2,9%

3,5%

1,9%

1,0%

6,4%

23,8%

0,3%

0,8%

3,9%

7,2%

12,6%

37,9%

1,3%

3,2%

5,5%

29,6%

12 mutations

13 mutations

14 mutations

15 mutations

16 mutations

17 mutations

0,3%

0,5%

0,8%

1,3%

2,3%

4,9%

2,6%

3,1%

4,6%

11,6%

14,2%

12,4%

0,3%

0,6%

0,3%

2,6%

1,6%

5,8%

10,0%

7,4%

Number of PI associated resistance mutations

147

Number of NNRTI associated resistance mutations

mutation

mutations

128

37,4%

Initial therapy between 1.1.1997 and 31.12.1999

Number of NRTI associated resistance mutations

145

No resistance test after ART

Initial therapy before 1.1.1997

149

136

1340

200

1140

0,1%

0,2%

1,0%

1,4%

2,1%

3,1%

3,7%

3,1%

0,1%

0,4%

1,1%

2,2%

11,1%

0,1%

0,3%

0,1%

0,4%

1,0%

2,7%

10,1%

100%

14,9%

85,1%

Initial therapy after 1.1.2000

Year of initial therapy

“Any” resistance R = 0,90

96 95

R = 0,89

Year of initial therapy

„“Any” y resistance

R = 0,61

Year of initial therapy

3-class-resistance

Year of initial NNRTI therapy

Resistance to NNRTI R = 0,64

Year of initial NNRTI therapy

Resistance to NRTI

R = 0,59

Year of initial PI therapy

Resistance to PI

R = 0,88

Year of initial PI therapy

Resistance to NRTI R = 0,64

13.2.7.4 Development of resistance after initial therapy with 2 NRTI + 1 PI

13.2.7.3 Development of resistance after initial ART with 2 NRTI + 1 NNRTI

04 03 02 01 00 99 Year of initial therapy

3-class-resistance R = 0,66

13.2.7.2 Any ART regimen and initial ART after January 1, 1997

Probability of development of resistance

13.2.7.1 Any ART regimen

13.2.7

% Cumulative Resistance

Cumulative resistance related to different time periods of ART initiation

% Cumulative Resistance

13.2.6

% Cumulative Resistance

129

96 95

130

10 (5,2%) 8 (9,4%)

N = 85

N = 192

$JH \HDUV PHDQ 6 '

)HGHUDO VWDWHV Carinthia Upper Austria Salzburg Styria Tyrol Other federal states Foreign countries Vienna *HQGHU Men Women 0RGH RI WUDQVPLVVLRQ MSM IDU Others/Missing Hetero $,'6 &' QDGLU FHOOV O PHDQ 6 ' &XUUHQW &' FHOO FRXQWV FHOOV O PHDQ 6 ' /DVW +,9 51$ log10 copies/ml (mean ± S. D.) < 400 copies/ml 50 copies/ml 'XUDWLRQ RI $57 PRQWKV PHDQ 6 '

3-class resistance

All centres AIDS related deaths after 1996 and ART > 6 months

AIDS related deaths after 1996

13.2.8.1 3-class-resistance in different populations

1,7 ± 1,0 124 (91,2%) 115 (84,6%) 157,5 ± 55,3

(69,9%) (30,1%)

95 41

48 (35,3%) 25 (18,4%) 10 (7,4%) 53 (39,0%) 76 (55,9%) 100,1 ± 89,1 535,9 ± 292,6

(1,5%) (32,4%) (6,6%) (8,1%) (17,6%) (8,1%) (0,7%) (25,0%)

2 44 9 11 24 11 1 34

45,7 ± 9,7

N = 136

(6,4%)

All centres

136

N = 2130

Current cohort and ART use ever

(6,8%) (6,4%)

95 / 1403 41 / 636

(5,3%) (8,0%)

54 / 1020 82 / 1019

/ / / /

(11,3%) (4,4%)

76 / 675 60 / 1364

(7,3%) (5,2%)

102 / 1390 34 / 649

Univariate regress ion p-value OR (95% CI)

0,64 1 1,05 1 1,19 1,31 1,48 1 1,43 1

2,76 1 5,98 3,42 1 0,61 0,60 1

7,40 1

0,45 –0,91

Multivariate regression* p-value OR (95% CI)

0,013

0,72 –1,54

0,785

0,80 –1,79 0,80 –2,14 0,73 –2,99

0,388 0,289 0,276

0,96 –2,14

1,94 –3,92

3,52 –10,14 2,05 –5,71

0,078

<0,001

<0,001 <0,001

4,67 2,91 1

0,229 0,398

0,27 –1,36 0,18 –1,98

5,15 –10,63

0,37 0,60

<0,001

7,00 1

2,70 –8,09 1,72 –4,95

<0,001 <0,001

0,15 –0,90 0,17 –2,15

4,70 –10,41

13.2.8.2 Risk factors for the development of 3-class-resistance

(7,0%) (7,6%) (8,5%) (5,9%)

690 331 118 900

48 25 10 53

(12,9%) (7,8%) (2,4%)

410 804 825

53 / 63 / 20 /

(0,0%) (6,6%) (6,4%) (10,3%)

(20,6%) (3,4%)

Patients with 3-class-resistance

Missing

/ 1 / 1892 / 78 / 68

80 / 388 56 / 1651

13.2.8

Model 1 (N = 2039)

All centres Frequencies N= 136 / 2039 (6,7%)

Variable Demographic characteristics $JH <44 years t 44 years *HQGHU Male Fem ale 0RGH RI WUDQVP LVVLRQ MSM IDU Others /mis sing Heterosexual $UHD RI UHVLGHQFH Non-m etropolitan Metropolitan Stage of disease $,'6 Yes No &' QDGLU <50 copies /μl 50-199 copies/μl t 200 copies/μl &XUUHQW +,9 51$

0 124 5 7

< 400 copies/m l 400-9999 copies /ml 10000 copies/m l ART $57 LQLWLDWLRQ Before 1.1.1997 After 1.1.1997

0,028 0,438

<0,001

131

*adjusted f or the variables: age, gender, mode of transmission, area of residence

Anal cancer (MSM)2

361

Drug overdose (mainly opiates)

384

105

167

Previous and/or current renal failure (N=384)

N = 1262

Currently Tenofovir

Current renal failure (N=105)

132

(15,8%)

(4,3%)

(10,6%)

(1,3%)

(2,0%)

(1,8%)

(14,9%)

(3,2%)

(6,0%)

(1,9%)

(5,6%)

(6,0%)

(1,2%)

(9,9%)

(3,7%)

(0,2%)

(1,2%)

(2,3%)

(3,4%)

(11,4%)

173

103

141

N = 632

<0,001

0,007

p-value

Chi-square

(33,5%)

(4,8%)

(19,1%)

(4,3%)

(5,0%)

(6,6%)

(19,9%)

(3,1%)

(14,7%)

(3,0%)

(18,2%)

(13,4%)

(0,0%)

(21,3%)

(3,5%)

(0,4%)

(2,3%)

(4,3%)

(6,6%)

(14,5%)

N= 517

Innsbruck

Currently Abacavir

Percentage related to women [745 in the current cohort (164 in Innsbruck)] Percentage related to MSM [857 in the current cohort (165 in Innsbruck)] Number related to current diseases

Renal failure Ń&#x2C6; stage 3

Renal failure stage 3, 4, 5 (ever)

Renal failure stage 3, 4, 5 (current)

257

Attempted suicide or suicide

Opiate dependency

HCV-related liver cirrhosis

Chronic hepatitis C

Chronic hepatitis B

146

Anal intraepithelial neoplasia II, III2

Osteoporosis

St. p. hysterectomy 1

CIN II or CIN III or carcinoma in situ1

Invasive cervical cancer1

Diabetes mellitus type II

Stroke

Myocardial infarction

Diabetes mellitus type I

Coronary heart disease

276

N= 2430

(Comorbidities ever documented)

Hypertension

All centres

Cumulative incidence

2QH DLP RI WKH $XVWULDQ +,9 &RKRUW 6WXG\ LV WR GRFXPHQW FRPRUELGLWLHV DQG DGYHUVH GUXJ UHDFWLRQV DV ZHOO DV WR LQYHVWLJDWH SRVVLEOH DVVRFLDWLRQV ZLWK $57 $V D ÂżUVW VWHS LPSRUWDQW FR PRUELGLWLHV DUH LOOXVWUDWHG

&2025%,',7,(6

259 531

Current opiat substitution Current therapy with psychotropic drugs

236

565

120

653

(9,7%)

(23,3%)

(4,9%)

(26,9%)

195

238

(14,7%)

(37,7%)

(11,8%)

(46,0%)

Innsbruck

(6,4%)

(20,7%)

N= 517

107

(16,4%)

(32,1%)

(16,2%)

(10,1%)

(3,9%)

(13,7%)

(0,4%)

(2,1%)

(1,9%)

(18,6%)

(4,6%)

(11,8%)

N= 2430

(5,6%)

(14,2%)

166

All centres

135

345

(9,2%)

(21,9%)

(10,7%)

(4,2%)

(2,6%)

(11,5%)

(1,8%)

(1,1%)

(2,3%)

(12,2%)

(5,8%)

(10,2%)

(11,8%)

Comparison of â&#x20AC;&#x153;co-medicationsâ&#x20AC;? used in HIV treatment centres run by dermatovenerologists and internal medicine specialists

Antipsychotics

Antidepressants

Bisphosphonates

Proton pump inhibitors

Previous and/or current therapies

Antipsychotics

Antidepressants

224

103

Thyroid hormones

Anxiolytics, hypnotics, sedatives

279

Proton pump inhibitors Bisphosphonates

26 43

Oral antidiabetic drugs

296

141

249

N= 517

(6,9%)

N= 2430 167

Innsbruck

All centres

Insulin

Fibrate

Statin

Beta blocker

ACE inhibitor therapy/ angiotensin antagonist

Acetylsalicylic acid

Current therapies

133

$QRWKHU DLP RI WKH $XVWULDQ +,9 &RKRUW 6WXG\ LV WR GRFXPHQW PHGLFDWLRQ IRU FRPRUELGLWLHV DQG DGYHUVH GUXJ UHDFWLRQV $V D ÂżUVW VWHS LPSRUWDQW FR PHGLFDWLRQV DUH LOOXVWUDWHG

134

13.3.2

New cases per year

13.3.1

Gender Male Female Mode of transmission MS M IDU Others/missing Heterosexual Diagnosis before/after ART initiation Before ART initiation After ART initiation Tota l (88, 76% ) (11, 24% ) (41, 57% ) (16, 85% ) (6,74%) (34,83%) (30,34%) (69,66%) (100, 00%)

79 10

37 15 6 31

27 62 89

35 13

15 13 2 18

18 30

Gender Male Female

Mode of transmission MS M IDU Others/missing Heterosexual

Diagnosis before/after ART initiation Before ART initiation After ART initiation

Tota l

(100,00%)

(37,50%) (62,50%)

(31, 25% ) (27, 08% ) (4,17%) (37,50%)

(72, 92% ) (27, 08% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Stroke

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Myocardial infarction

13.3.4

13.3.3

New cases per year

(0,33%) (99,67%) (100, 00%)

Diagnosis before/after ART initiation Before ART initiation 1 After ART initiation 305 Tota l

(2,54%) (97,46%) (100, 00%)

24 21 12 61

Mode of transmission MS M IDU Others/missing Heterosexual

Diagnosis before/after ART initiation Before ART initiation 3 After ART initiation 115 Tota l

118

(20, 34% ) (17, 80% ) (10,17%) (51,69%)

56 62

Gender Male Female

(47, 46% ) (52, 54% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

306

(30, 07% ) (23, 86% ) (7,84%) (38,24%)

92 73 24 117

Mode of transmission MS M IDU Others/missing Heterosexual

(66, 67% ) (33, 33% )

204 102

Gender Male Female

Lipoaccumulation

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Lipoatrophy 70

New cases per year

135

136

13.3.6

13.3.5

New cases per year

5 6

1 1 2 7

0 11

Gender Male Female

Mode of transmission MS M IDU Others/missing Het eros ex ual

Diagnosis before/after ART initiation Before ART initiation After ART initiation

Tota l

Gender Male 121 Female 26 Mode of transmission MS M 46 IDU 15 Others/missing 18 Heterosexual 68 Diagnosis before/after ART initiation Before ART initiation 48 After ART initiation 99 Tota l 147 (32,65%) (67,35%) (100, 00%)

(31, 29% ) (10, 20% ) (12,24%) (46,26%)

(82, 31% ) (17, 69% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

(100, 00%)

(0,00%) (100,00%)

(9,09% ) (9,09% ) (18,18%) (63,64% )

(45,45% ) (54,55% )

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Diabetes mellitus

Symptomatic hyperlactatemia y y

250

300

350

13.3.7

100

120

140

160

180

200

220

240

260

100

150

200

mg/dl mg/dl Percent

N = 1904

N = 240

N = 96

Never ART

N = 632

Ever ART

N = 1732

N = 230

HbA1c

Ever ART

Never ART

LDL-cholesterol

Ever ART

Never ART

Total cholesterol

400

500

600

100

N = 240

Never ART

83 / 2430 76 / 20 / 8/ 44 /

Coronary Heart Disease (CHD) CHD and LDL cholesterin measured CHD and LDL>130 Diabetes and HbA1c>8 Diabetes and no recent HbA1c

26 /

LDL>160mg/dl and smoking and no statin

34 / 348

LDL>160mg/dl and smoking

680 / 2430 348 / 680

188 / 231

LDL>160 and no statin Smoking explored Smoking

231 / 1962

1962 / 2430

N = 1905

Ever ART

LDL>160mg/dl

LDL cholesterol measured

"Quality control"

100

200

300

N = 1855

N = 237

Triglycerides

Ever ART

Never ART

HDL-cholesterol

Lipid metabolism abnormalities (current cohort)

mg/dl mg/dl

46,8%

8,5%

26,3%

91,6%

3,4%

76,5%

9,8%

28,0% 51,2%

81,4%

11,8%

80,7%

137

Frequencies N= 105 / 2430 (4,32%)

Univariate regression p-value OR (95% CI)

138

<0,001

0,040 0,088

<0,001

Model 1 (N = 2430) Multivariate regression* p-value OR (95% CI)

Demographic characteristics $JH <0,001 <43 years 23 / 1215 (1,89%) 0,27 0,17 - 0,43 0,29 0,18 –0,46 82 / 1215 (6,75%) 1 1 t 43 years *HQGHU Male 62 / 1685 (3,68%) 0,62 0,42 - 0,93 0,020 Female 43 / 745 (5,77%) 1 0RGH RI WUDQVPLVVLRQ 0,007 MSM 22 / 857 (2,57%) 0,50 0,30 - 0,82 IDU 24 / 384 (6,25%) 1,26 0,76 - 2,07 0,368 0,739 Others/missing 6 / 137 (4,38%) 0,86 0,36 - 2,05 Heterosexual 53 / 1052 (5,04%) 1 %RG\ 0DVV ,QGH[ 18 / 443 (4,06%) Missing 50 / 1055 (4,74%) 0,403 < 24 1,20 0,78 - 1,86 37 / 932 (3,97%) 1 t 24 Comorbidity &KURQLF KHSDWLWLV & Yes 21 / 361 (5,82%) 1,46 0,89 - 2,39 0,132 No 84 / 2069 (4,06%) 1 /LYHU FLUUKRVLV 0,018 Yes 6 / 54 (11,11%) 2,87 1,20 - 6,88 No 99 / 2376 (4,17%) 1 Stage of disease $,'6 <0,001 Yes 46 / 701 (6,56%) 1,99 1,34 - 2,95 No 59 / 1729 (3,41%) 1 &' QDGLU <0,001 <50 copies/μl 31 / 426 (7,28%) 3,22 1,91 - 5,44 1,81 1,03 –3,18 50-199 copies/μl 46 / 827 (5,56%) 2,42 1,50 - 3,90 <0,001 1,55 0,94 –2,57 28 / 1177 (2,38%) 1 1 t 200 copies/μl &XUUHQW &' FHOO FRXQW < 350 cells/μl 35 / 546 (6,41%) 1,77 1,17 - 2,69 0,007 70 / 1884 (3,72%) 1 t 350 cells/μl ART $57 XVH HYHU Yes 105 / 2130 (4,93%) No 0 / 300 (0,00%) &XUUHQW 7HQRIRYLU XVH Yes 41 / 1262 (3,25%) 0,58 0,39 - 0,86 0,008 0,44 0,29 –0,66 No 1 64 / 1168 (5,48%) 1 * adjusted for the variables: gender, mode of transmission, Body Mass Index and ART use ever

Variable

All centres

,QFOXGHG DUH DOO SHUVRQV LQ WKH FXUUHQW FRKRUW

&XUUHQW FRKRUW

13.3.9

Centre Innsbruck

Risk factors for current renal insuf ciency (stage 3, 4, 5) Model 2 (N = 517) Multivariate regression** OR (95% CI) p-value Model 1 (N = 517) Multivariate regression* OR (95% CI) p-value Univariate regression OR (95% CI) p-value Frequencies N= 76 / 517 (14,70%) Variable

Risk factors for osteoporosis <0,001 0,22 0,11 –0,41 1 <0,001 0,13 –0,46 0,24 1 <0,001 0,10 - 0,33 0,18 1 259 258 14 / 62 /

(5,41%) (24,03%)

0,193 0,43 - 1,18 0,72 1 353 164 47 / 29 /

(13,31%) (17,68%)

0,729 <0,001 0,261 0,46 - 1,72 1,79 - 5,76 0,04 - 2,39 0,89 3,21 0,31 1 165 116 26 210 / / / / 17 34 1 24

(10,30%) (29,31%) (3,85%) (11,43%)

0,039 1,03 - 2,77 1,69 1 256 261 46 / 30 /

(17,97%) (11,49%)

0,020 1,10 - 3,00 1,82 1 262 255 48 / 28 /

(18,32%) (10,98%)

<0,001 1,44 - 4,19 2,46 1 103 414 26 / 50 /

(25,24%) (12,08%)

<0,001 2,44 - 9,41 4,79 1 42 475 17 / 59 /

(40,48%) (12,42%)

0,007 1,24 –3,82 2,18 1 <0,001 2,42 - 6,71 4,03 1 186 331 49 / 27 /

(26,34%) (8,16%)

0,004 0,063 3,25 1,47 –7,19 1,96 0,96 –4,00 1 <0,001 <0,001 2,62 - 11,11 1,77 - 6,42 5,40 3,37 1 86 210 221 23 / 39 / 14 /

(26,74%) (18,57%) (6,33%)

0,009 1,94 - 103,46 14,15 1 (16,82%) (1,41%) 446 71 75 / 1 /

Demographic characteristics $JH <44 years t 44 years *HQGHU Male Female 0RGH RI WUDQVPLVVLRQ MSM IDU Others/missing Heterosexual 6PRNLQJ Yes No %RG\ 0DVV ,QGH[ < 24 t 24 Comorbidity &KURQLF KHSDWLWLV & Yes No /LYHU FLUUKRVLV Yes No Stage of disease $,'6 Yes No &' QDGLU <50 copies/μl 50-199 copies/μl t 200 copies/μl ART $57 XVH HYHU Yes No

13.3.8

139

** adjusted for the variables: gender, mode of transmission, smoking, chronic hepatitis C, liver cirrhosis and ART use ever * adjusted f or the variables: gender, mode of transmission, smoking, chronic hepatitis C, liver cirrhosis and ART use ever

SUMMARY

142

7KH FRKRUW VWXG\ UHFRUGV WKH QXPEHU RI WKH LQFOXGHG SDWLHQWV WKH QXPEHU RI SDWLHQWV RQ $57 DSSUR[LPDWHO\ WZR WKLUGV RI DOO SDWLHQWV RQ $57 LQ $XVWULD DUH LQFOXGHG LQ WKH FRKRUW WKH QXPEHU RI Â³ODWHÂ³ SUHVHQWHUV DQG Â¿QDOO\ WKH QXPEHU RI WKH SDWLHQWV ZKR GLHG ZLWK RU ZLWKRXW $,'6 :H HVWLPDWH WKDW WKHUH DUH FXUUHQWO\ DERXW +,9 LQIHFWHG SHUVRQV OLYLQJ LQ $XVWULD

:+2 $1' +2: 0$1< $5( ,1)(&7(' :,7+ +,9 ,1 $8675,$"

PDQ\ JUDSKV DQG FDOFXODWLRQV GDWD ZHUH DQDO\VHG RQO\ RI WKRVH SDWLHQWV ZKR KDG D PHDVXUHPHQW RI WKH &' FHOO FRXQW ZLWKLQ WKH SUHYLRXV PRQWKV Â³FXUUHQW FRKRUWÂ³ )RU WKH HYDOXDWLRQ RI WKH HIÂ¿FDF\ RI DQWLUHWURYLUDO WKHUDS\ YLUDO VXSSUHVVLRQ LQFUHDVH RI WKH &' FHOOV RQO\ SDWLHQWV ZKR KDG EHHQ RQ DQWLUHWURYLUDO WKHUDS\ IRU DW OHDVW PRQWKV ZHUH DQDO\VHG

XSÂ´ FRXOG EH PLVVLQJ HQWU\ RI SDWLHQW GDWD PXOWLSOH HQWU\ RI LQGLYLGXDO SDWLHQWV LQ PRUH WKDQ RQH FHQWUH D FKDQJH WR KHDOWK FDUH SURYLGHUV RXWVLGH WKH +,9 FHQWUHV RI $+,9&26 DQG RU ODFN RI NQRZOHGJH RI GHDWK )RU

7KH KLJKHVW QXPEHU RI FRKRUW SDUWLFLSDQWV DUH WUHDWHG DW WKH $.+ 9LHQQD IROORZHG E\ ,QQVEUXFN /LQ] *UD] 6DO]EXUJ DQG .ODJHQIXUW +RZHYHU D FRQVLGHUDEOH SRUWLRQ RI SDWLHQWV GLG QRW KDYH D IROORZ XS ZLWKLQ WKH ODVW PRQWKV 5HDVRQV IRU WKLV Â³ORVV RI IROORZ

&216758&7,21 2) $ Â³&855(17 &2+257Â´

FOHDU DWWULEXWLRQ H J ,&' FRGH

REYLRXV 7KH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP DOVR DOORZV WKH GRFXPHQWDWLRQ RI WKHVH GLVHDVHV ZLWKRXW D

3UREOHPV GXH WR LQDGHTXDWH LQSXW RI GDWD FRQFHUQLQJ FRLQIHFWLRQV DQG QRW $,'6 GHÂ¿QLQJ GLVHDVHV DUH PRVW

ZDV QR DFFHSWDQFH IRU D SXUHO\ VFLHQWLÂ¿F GDWD EDVH :KLOH IRU WKH FOLQLFDO SDWLHQW PDQDJHPHQW WKH IRFXV LV RQ UHDGDELOLW\ RI GLDJQRVHV DQG WKHUDSLHV FUHDWLRQ RI PHGLFDO UHSRUWV SUHVFULSWLRQV WUDGH QDPHV SULQW RXW RI UHVXOWV HWF VFLHQWLÂ¿F TXHULHV QHHG SUHFLVH FRGLQJ DQG FDWHJRUL]DWLRQ )XUWKHUPRUH WKH RSWLPL]DWLRQ RI LQGLYLGXDO SDWLHQW PDQDJHPHQW UHTXLUHV DQ RQJRLQJ DGMXVWPHQW WR WKH SURJUHVV RI LQIRUPDWLRQ WHFKQRORJ\ ZKHUHDV SXUHO\ VFLHQWLÂ¿F GDWD EDVHV GR QRW KDYH VXFK WHFKQRORJLFDO UHQHZDO SUHVVXUH

+,9 LQIHFWHG SDWLHQWV DQG RQ WKH RWKHU KDQG LW DOORZV TXHULHV DQG DQDO\VHV WR EH SHUIRUPHG E\ WKH XVHUV ZLWKRXW UHVWULFWLRQV +RZHYHU WR DOORZ ERWK LQGLYLGXDO SDWLHQW PDQDJHPHQW DQG VFLHQWLÂ¿F TXHULHV LV DQ HQRUPRXV FKDOOHQJH ZKLFK VFLHQWLÂ¿F +,9 FRKRUWV LQ RWKHU FRXQWULHV KDYH QRW KDG WR GHDO ZLWK ,Q $XVWULD WKHUH

2Q WKH RQH KDQG WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP IXOÂ¿OOV FRPSOH[ WDVNV IRU WKH FOLQLFDO PDQDJHPHQW RI

WLFLSDQWV KDYH EHHQ PDGH DQRQ\PRXV 7KHUHIRUH LW LV YHU\ ODERULRXV WR LGHQWLI\ FRKRUW SDUWLFLSDQWV ZKR DUH ZHUH WUHDWHG LQ PRUH WKDQ MXVW RQH WUHDWPHQW FHQWUH 7KLV FDQQRW EH GRQH E\ WKH XVH RI SHUVRQDO GDWD VXFK DV LQLWLDOV ELUWKGD\ RU SRVWDO FRGH EXW ZLWK +,9 VSHFLÂ¿F GDWD GDWH RI WKH +,9 WHVW &' FHOO FRXQWV HWF

$ VSHFLDO VRIWZDUH WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP LV WKH FRPPRQ WRRO IRU WKH +,9 &RKRUW 7KH GDWD LQSXW LV GRQH GHFHQWUDOL]HG LQ WKH +,9 FHQWUHV 7KH LQSXW RI ODERUDWRU\ UHVXOWV LV GRQH PRVWO\ HOHFWURQLFDOO\ DQG LQ HYHU\ FHQWUH YDULRXV SURIHVVLRQDO JURXSV DUH LQYROYHG LQ GDWD HQWU\ %HIRUH GDWD LV PHUJHG WKH FRKRUW SDU-

+,9 3$7,(17 0$1$*(0(17 6<67(0

14. SUMMARY

143

7KXV QHDUO\ KDOI RI WKH SDWLHQWV DUH GLDJQRVHG ODWH DQG D WKLUG RI SDWLHQWV DUH GLDJQRVHG Â³DGYDQFHGÂ´ DQG WKLV KDV QRW FKDQJHG LQ WKH ODVW \HDUV VHH DOVR FKDSWHU

WHURVH[XDOO\ 7KH UHVXOWV ZHUH WKH VDPH IRU DQ Â³DGYDQFHGÂ´ GLDJQRVLV $Q Â³HDUO\Â´ GLDJQRVLV ZDV IRXQG PRUH IUHTXHQWO\ LQ 060 SDWLHQWV RULJLQDWLQJ IURP $XVWULD DQG RWKHU ORZ SUHYDOHQFH FRXQWULHV DQG LQ SHUVRQV QRW OLYLQJ LQ D PHWURSROLWDQ FLW\

$ KLJKHU ULVN WR KDYH D Â³ODWHÂ´ GLDJQRVLV ZDV IRXQG LQ ROGHU SDWLHQWV DQG WKRVH ZKR KDYH EHHQ LQIHFWHG KH-

YDQFHGÂ´ GLDJQRVLV

RI WKH H[DPLQHG SDWLHQWV KDG DQ Â³HDUO\Â³ GLDJQRVLV D Â³ODWHÂ³ GLDJQRVLV DQG KDG DQ Â³DG-

$Q Â³DGYDQFHGÂ³ GLDJQRVLV LV GHÂ¿QHG E\ &' DW WLPH RI +,9 GLDJQRVLV DQG RU $,'6 ZLWKLQ PRQWKV RI +,9 GLDJQRVLV

GLDJQRVLV

$ Â³ODWHÂ³ GLDJQRVLV LV GHÂ¿QHG E\ &' DW WLPH RI +,9 GLDJQRVLV DQG RU $,'6 ZLWKLQ PRQWKV RI +,9

$Q Â³HDUO\Â³ GLDJQRVLV LV GHÂ¿QHG E\ D VHURFRQYHUVLRQ LOOQHVV +,9 LQIHFWLRQ ZHVWHUQEORW SDWWHUQ RU DQWLJHQ +,9 51$ ZLWK FRUUHVSRQGLQJ FOLQLFDO V\PSWRPV RU GRFXPHQWHG VHURFRQYHUVLRQ ZLWK QHJDWLYH WHVW QRW PRUH WKDQ \HDUV EHIRUH WKH Â¿UVW SRVLWLYH +,9 WHVW

7KHUHIRUH ULVN IDFWRUV IRU DQ Â³HDUO\Â³ DQG D Â³ODWHÂ³ GLDJQRVLV KDYH EHHQ HYDOXDWHG 3DWLHQWV ZKR KDYH EHHQ GLDJQRVHG ZLWK +,9 EHWZHHQ DQG ZHUH DQDO\VHG 'XULQJ WKLV SHULRG +,9 LQIHFWLRQV ZHUH GLDJQRVHG PDOH IHPDOH 7KH LQIHFWLRQV RFFXUUHG LQ WKURXJK KHWHURVH[XDO WUDQVPLVVLRQ LQ WKURXJK 060 DQG LQ WKURXJK ,'8

$XVWULD KDV RQH RI WKH KLJKHVW UDWHV RI +,9 WHVWV SHU FDSLWD LQ (XURSH 1HYHUWKHOHVV D VXEVWDQWLDO QXPEHU RI SDWLHQWV LV DOUHDG\ LPPXQH GHÂ¿FLHQW &' FHOO FRXQW Â&#x2014;O DW WKH WLPH RI WKH Â¿UVW FRQWDFW ZLWK DQ +,9 FHQWUH

,6 7+( +,9 7(67 86(' ()),&,(17/<"

0RVW RI WKH FRKRUW SDUWLFLSDQWV DUH $XVWULDQ QDWLRQDOV FRPH IURP KLJK SUHYDOHQFH FRXQWULHV DQG IURP ORZ SUHYDOHQFH FRXQWULHV RXWVLGH $XVWULD ,QIRUPDWLRQ RQ WKH QDWLRQDOLW\ RI WKH UHPDLQLQJ SDWLHQWV LV PLVVLQJ

7KH PHGLDQ DJH DW WKH GLDJQRVLV OLHV EHWZHHQ DQG \HDUV VLQFH RI WKH FRKRUW SDUWLFLSDQWV DUH IHPDOH 7KH UDWH LV KLJKHVW LQ 8SSHU $XVWULD DQG 9RUDUOEHUJ ,Q WKH VXEJURXS RI WKH KHWHURVH[XDOO\ LQIHFWHG WKH UDWH RI WKH ZRPHQ LV ,W LV KLJKHVW LQ 9LHQQD 8SSHU $XVWULD DQG 9RUDUOEHUJ $PRQJ SDWLHQWV QHZO\ GLDJQRVHG LQ KDYH EHHQ LQIHFWHG WKURXJK KHWHURVH[XDO FRQWDFWV 6LQFH RI QHZO\ GLDJQRVHG +,9 LQIHFWLRQV ZHUH WUDQVPLWWHG WKURXJK KHWHURVH[XDO FRQWDFWV

144

FRKRUWÂ³ DQG WKDW SDWLHQWV ZLWK Â³ORVV RI IROORZ XSÂ³ DUH QRW LQFOXGHG

7KH UDWH RI YLUDO VXSSUHVVLRQ XQGHU DQWLUHWURYLUDO WKHUDS\ LQ $XVWULD LV VLPLODU WR Â¿JXUHV IURP RWKHU FRXQWULHV +RZHYHU LW KDV WR EH FRQVLGHUHG WKDW WKH UDWH RI YLUDO VXSSUHVVLRQ KDV EHHQ PHDVXUHG ZLWK WKH Â³FXUUHQW

9,5$/ 68335(66,21 81'(5 $17,5(7529,5$/ 7+(5$3<

WKURXJK 060 RU ,'8 0RUWDOLW\ ZDV KLJKHU ZKHQ $,'6 ZDV GLDJQRVHG LQ WKH HDUOLHU \HDUV RI WKH HSLGHPLF EHIRUH

)DFWRUV DVVRFLDWHG ZLWK LQFUHDVHG PRUWDOLW\ DIWHU WKH GLDJQRVLV $,'6 LQFOXGH DJH EHORZ \HDUV WUDQVPLVVLRQ

DQG IRU ZRPHQ 2YHU WKH ODVW \HDUV WKH UDWH GHFUHDVHG WR EHORZ IRU PHQ DQG EHORZ IRU ZRPHQ %HWZHHQ DQG H[FHSW IRU WKH \HDU LQMHFWLQJ GUXJ XVHUV KDG D KLJKHU GHDWK UDWH WKDQ KRPRVH[XDO PHQ 2QO\ LQ WKH GHDWK UDWH RI KRPRVH[XDO PHQ ZDV KLJKHU WKDQ IRU ,'8

7KH UHGXFWLRQ RI PRUWDOLW\ DIWHU WKH LPSOHPHQWDWLRQ RI DQWLUHWURYLUDO FRPELQDWLRQ WKHUDSLHV LV LPSUHVVLYH VHH LWHPV DQG ,Q WKH GHDWK UDWH RI SDWLHQWV ZLWK $,'6 ZDV SHU SHUVRQ \HDUV IRU PHQ

0257$/,7<

7KH FRKRUW SDUWLFLSDQWV UHSUHVHQW DOO VWDJHV RI +,9 LQIHFWLRQ +DOI RI WKH SDWLHQWV KDYH D &' QDGLU Â&#x2014;O 7KH PHGLDQ RI WKH &' QDGLU LQ WKH FXUUHQW FRKRUW LV Â&#x2014;O 7KH FXUUHQW &' FHOO FRXQW LV Â&#x2014;O PHGLDQ DW WKH ODVW PHDVXUHPHQW $V RI -DQXDU\ RI WKH SDUWLFLSDQWV LQ WKH FRKRUW VWXG\ KDG D &' FHOO FRXQW EHORZ Â&#x2014;O DQG RQO\ KDG D &' FHOO FRXQW Â&#x2014;O 7KH PHDQ &' FHOO FRXQW LV FXUUHQWO\ Â&#x2014;O 7KHUHIRUH WKH QXPEHU RI SDWLHQWV ZLWK DQ RSSRUWXQLVWLF LQIHFWLRQ ZLOO UHPDLQ ORZ LQ WKH IROORZLQJ \HDUV

67$*( 2) +,9 ',6($6(

7KH &' FHOOV GXULQJ DQWLUHWURYLUDO WKHUDS\ KDYH FRQWLQXRXVO\ LQFUHDVHG DQG WKH LQFUHDVH FRQWLQXHV DIWHU DQG \HDUV RI $57 LQLWLDWLRQ 7KH LQFUHDVH LV IDVWHU LQ SDWLHQWV RQ FRQWLQXRXV $57 FRPSDUHG WR SDWLHQWV ZLWK WUHDWPHQW LQWHUUXSWLRQV VHH LWHP

RI SDWLHQWV ZHUH LGHQWLÂ¿HG ZKR KDG DW OHDVW RQH UHVLVWDQFH PXWDWLRQ EHIRUH WKHLU Â¿UVW DQWLUHWURYLUDO WKHUDS\ 2QH SDWLHQW KDG D FODVV UHVLVWDQFH WR 157, 1157, DQG 3, EHIRUH VWDUWLQJ $57 7KUHH SDWLHQWV KDG D UHVLVWDQFH WR 157, DQG 3, RQH SDWLHQW KDG D UHVLVWDQFH WR 157, DQG 1157, 7KH WUDQVPLVVLRQ RI GUXJ UHVLVWDQW +, YLUXVHV KDV GHFUHDVHG LQ WKH ODVW \HDUV +RZHYHU QRW DOO FHQWUHV GLG UHVLVWDQFH WHVWV EHIRUH $57 LQLWLDWLRQ RU DW GLDJQRVLV EXW PRVW KDYH LPSOHPHQWHG WKH URXWLQH WHVWLQJ LQ

EH IRXQG PRUH RIWHQ LQ SDWLHQWV ZLWK DGYDQFHG LPPXQH GHÂ¿FLHQF\ &' QDGLU $,'6 FKDSWHU

145

,Q RXU FRKRUW SDWLHQWV RI KDYH D PXWDWLRQ RI WKH FRGRQ RI WKH 57 . 5 7KH RFFXUUHQFH RI WKH PXWDWLRQ . 5 ZDV PRUH IUHTXHQW LQ UHJLPHQV LQFOXGLQJ 7HQRIRYLU FRPSDUHG ZLWK $EDFDYLU DQG FRXOG

7KH VWURQJHVW ULVN IDFWRU IRU WKH GHYHORSPHQW RI DQ\ UHVLVWDQFH GXULQJ DQWLUHWURYLUDO WKHUDS\ LV LQLWLDWLRQ RI $57 EHIRUH IROORZHG E\ D ORZ &' QDGLU

FODVV UHVLVWDQFH 7KH SUREDELOLW\ RI 1157, DVVRFLDWHG UHVLVWDQFH DIWHU \HDUV LV LQ SDWLHQWV ZKR VWDUWHG $57 ZLWK 1157,V 7KH SUREDELOLW\ RI 3, DVVRFLDWHG UHVLVWDQFH DIWHU \HDUV LV LQ SDWLHQWV ZKR KDG D 3, EDVHG DQWLUHWURYLUDO FRPELQDWLRQ WKHUDS\ DV WKHLU LQLWLDO WKHUDS\

7KH SUREDELOLW\ RI GHYHORSLQJ UHVLVWDQFH WR DQWLUHWURYLUDO GUXJV VHHPV WR EH GHFUHDVLQJ FKDSWHU 6R WKH ULVN RI Â³DQ\Â´ UHVLVWDQFH DIWHU \HDUV RI $57 LV DERXW IRU 157, DVVRFLDWHG UHVLVWDQFH DQG IRU

'(9(/230(17 2) 5(6,67$1&(6 '85,1* $17,5(7529,5$/ 7+(5$3<

7KH VL[ +,9 FHQWUHV KDYH WR FDUH IRU DQ LQFUHDVLQJ QXPEHU RI SDWLHQWV RQ DQWLUHWURYLUDO WUHDWPHQW 7KLV ZDV D QDWXUDO GHYHORSPHQW WKHUH ZDV QR SXEOLF KHDOWK SROLF\ ZKLFK SXVKHG WKH WUHDWPHQW LQWR WKH +,9 FHQWUHV 2QH PLJKW VD\ Â³WKH PDUNHW ZDQWV LW WKDW ZD\Â³

$ PLQRULW\ RI WKH VWXG\ SDUWLFLSDQWV GRHV QRW RULJLQDWH IURP $XVWULD $ERXW RI WKH KHWHURVH[XDOO\ LQIHFWHG SHUVRQV DUH QRQ $XVWULDQ QDWLRQDOV 7KH DFFHVV WR DQWLUHWURYLUDO WKHUDS\ IRU SHUVRQV RULJLQDWLQJ IURP KLJK SUHYDOHQFH FRXQWULHV DSSHDUV PRUH GLIÂ¿FXOW WKDQ IRU $XVWULDQV VHH LWHP 3DWLHQWV IURP KLJK SUHYDOHQFH FRXQWULHV DQG ZLWK D &' QDGLU Â&#x2014;O RU Â&#x2014;O DUH OHVV OLNHO\ WR EH RQ $57 7KH VDPH LV WUXH IRU LQMHFWLQJ GUXJ XVHUV

,Q JHQHUDO WKH $XVWULDQ +,9 &RKRUW 6WXG\ FDQQRW HYDOXDWH LI WKH DFFHVV WR WKH +,9 FHQWUHV GLIIHUV E\ JHQGHU PRGH RI WUDQVPLVVLRQ QDWLRQDOLW\ RU RWKHU IDFWRUV DQG ZKHWKHU WKHVH LQÃ&#x20AC;XHQFH WKH DFFHVV WR DQWLUHWURYLUDO WKHUDS\ 7KH +,9 &RKRUW 6WXG\ GDWD VKRZ WKH IROORZLQJ SLFWXUH

$&&(66 72 $17,5(7529,5$/ 7+(5$3<

,1&5($6( 2) &' &(// &28176 '85,1* $17,5(7529,5$/ 7+(5$3<

75$160,66,21 2) '58* 5(6,67$17 +,9 Â³5(6,67$1&( %()25( 7+(5$3<Â´

146

&$6&$'( DQG &2+(5( KDV EHHQ DQG ZLOO EH JUHDWO\ IDFLOLWDWHG :LWK WKLV WKH $XVWULDQ +,9 &RKRUW 6WXG\ LV ORRNLQJ IRUZDUG WR MRLQ WKH LQWHUQDWLRQDO QHWZRUN RI FRKRUWV OLNH $57 && &$6&$'( DQG &2+(5(

+,9 &RKRUWV 'DWD ([FKDQJH 3URWRFRO +,&'(3 VR WKDW GDWD PHUJLQJ ZLWK QHWZRUNV RI FRKRUWV OLNH $57 &&

7KH GHYHORSPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP LQFRUSRUDWHG WKH LQWHUQDWLRQDO VWDQGDUG IRUPDW WKH

RI SUREOHPV DUH GXH WR LQFRQVLVWHQW XVH RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP ZLWK WKH FRUROODU\ RI LQFRQVLVWHQW GDWD HQWU\ LQWR WKLV VRIWZDUH 5HJXODU XSGDWHV DQG LPSURYHPHQWV RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP VKRXOG KHOS WR IDFH WKHVH FKDOOHQJHV

LPSURYHG FOLQLFDO FDUH IRU SHUVRQV ZLWK +,9 $,'6 Â³*RRG &OLQLFDO &KURQLF 'LVHDVH 3UDFWLFHÂ´ %XW LW ZDV DOVR FOHDU WKDW VKRUWFRPLQJV RI WKH $XVWULDQ +,9 &RKRUW 6WXG\ ZRXOG EHFRPH PRUH REYLRXV $ ORW

7KH UHSRUW RI WKH $XVWULDQ +,9 &RKRUW 6WXG\ KDV EHFRPH PRUH FRPSUHKHQVLYH LQ UHFHQW \HDUV 7KHUHIRUH WKH FXUUHQW UHSRUW FDQ EH FRPSDUHG ZHOO WR RWKHU UHSRUWV H J UHSRUW RI UHQDO WKHUDS\ RI WKH $XVWULDQ 6RFLHW\ IRU 1HSKURORJ\ DQG $XVWURWUDQVSODQW 0RUHRYHU WKH HVWDEOLVKPHQW RI WKH +,9 3DWLHQW 0DQDJHPHQW 6\VWHP KDV

287/22.

$ UHODWLYHO\ KLJK QXPEHU RI SDWLHQWV LV VXIIHULQJ IURP RWKHU FKURQLF GLVHDVHV VXFK DV SV\FKLDWULF GLVRUGHUV HVSHFLDOO\ GHSUHVVLRQ RVWHRSRURVLV DQG GLDEHWHV 2I VSHFLDO FRQFHUQ DUH FDUGLRYDVFXODU GLVHDVHV DQG WKH ULVN RI P\RFDUGLDO LQIDUFWLRQV 8QIRUWXQDWHO\ GDWD HQWU\ UHJDUGLQJ FRPRUELGLWLHV LV VWLOO LQFRPSOHWH LQ VRPH FHQWUHV 7KH LPSURYHPHQW RI GDWD HQWU\ LV RQH RI WKH FKDOOHQJHV IRU WKH $XVWULDQ +,9 &RKRUW 6WXG\

&2025%,',7<

&RLQIHFWLRQV ZLWK V\SKLOLV KHSDWLWLV % DQG KHSDWLWLV & DUH FRPPRQ /LNH LQ RWKHU (XURSHDQ FRXQWULHV DQ HQRUPRXV LQFUHDVH RI QHZ V\SKLOLV LQIHFWLRQV HVSHFLDOO\ DPRQJ KRPRVH[XDO PHQ LV DSSDUHQW 7KLV LQGLFDWHV D ODFN RI SUHYHQWLRQ DQG Â³6DIHU 6H[Â´ SUDFWLFHV +RZHYHU LW LV QHFHVVDU\ WR QRWH WKDW DQ LQFUHDVHG Â³VHURVRUWLQJÂ³ EHKDYLRXU VH[XDO FRQWDFWV ZLWK SDUWQHUV ZLWK WKH VDPH +,9 VWDWXV FRXOG KDYH FRQWULEXWHG HVVHQWLDOO\ WR WKLV LQFUHDVH ,Q $XVWULD LQIHFWLRQ ZLWK KHSDWLWLV & LV XQFRPPRQ LQ KRPRVH[XDO PHQ 7KLV VXSSRUWV WKH DVVXPSWLRQ WKDW WKH WUDQVPLVVLRQ RI KHSDWLWLV & RQO\ KDSSHQV LQ VSHFLDO FLUFXPVWDQFHV H J SDUHQWHUDO GUXJV WUDXPD 1RW DOO SDWLHQWV DUH RIIHUHG YDFFLQDWLRQ DJDLQVW KHSDWLWLV % DOWKRXJK LW LV UHFRPPHQGHG IRU DOO +,9 LQIHFWHG SHUVRQV

&2,1)(&7,216

HBA1c HBV HCV HDL HIP ICD IDU CHD LA LDL m. miss. MSM n.a. n.s. neg. NNRTI NRTI OWS P PI Rep. RNA RT S s.d. St St. p. T UA UK vertical Vi Vo WHO ys.

A ab ACE AGES AHIVCOS ART ATC-Code B betw. BMG C CDC CIN CIS def. ECDC EuroHIV for. c. GP

Austria antibody Angiotensin-converting enzyme Austrian Agency for Health and Food Safety Austrian HIV-Cohort Study antiretroviral therapy (HIV-therapy) anatomical therapeutic-chemical code Burgenland between Federal Ministry of Health Carinthia Centers for Disease Control cervical intraepithelial neoplasia Commonwealth of Independent States defining European Cenre for Disease Prevention and Control European Centre for the Epidemiological Monitoring of AIDS foreign countries general practitioner hemoglobin A1c hepatitis B hepatitis C high density lipoprotein HIV-Patient-Management-System International Classification of Diseases (WHO) injecting drug users coronary heart disease Lower Austria low density lipoprotein month(s) missing men who have sex with men not available not significant negative Non Nucleoside Reverse Transcriptase Inhibitor Nucleoside Reverse Transcriptase Inhibitor Otto-Wagner-Spital Wien/Otto-Wagner Hospital Vienna protease protease inhibitor republic ribonucleic acid reverse transcriptase Salzburg standard deviation Styria status post Tyrol Upper Austria United Kingdom vertical transmission Vienna Vorarlberg World Health Organization years

15. GLOSSARY

147

$V RI $SULO

148

)UDQ] $OOHUEHUJHU 0 ' $*(6 *PE+

25*$1,6$7,21

*UDSKLF 'HVLJQ &RUVDUR *UDSKLF 'HVLJQ 3KRWRV 0LFKDHO 5DWKPD\HU

$OO ULJKWV UHVHUYHG 5HSURGXFWLRQ RU IXUWKHU GLVWULEXWLRQ HOHFWURQLFDOO\ RU RWKHUZLVH DOVR LQ H[WUDFWV RQO\ ZLWK SULRU ZULWWHQ FRQVHQW RI $*(6 $XVWULDQ $JHQF\ IRU +HDOWK DQG )RRG 6DIHW\

Â&#x2039; $*(6 0D\

ZZZ DJHV DW

0DULD .LWFKHQ 0 ' 0DULR 6DUFOHWWL 0 ' 5REHUW =DQJHUOH 0 '

3XEOLVKHG E\ $*(6 $XVWULDQ $JHQF\ IRU +HDOWK DQG )RRG 6DIHW\ $ 9LHQQD 6SDUJHOIHOGVWUDÂ&#x2030;H

Imprint:

6WHIDQLH *RJO 0DUJUHW -|FKO

$87+256

Scienti c advisory board: %UXQR /HGHUJHUEHU =XULFK *HUG )lWNHQKHXHU &RORJQH

Data safety and protection: .ODXV 6FKLQGHOZLJ 7,/$. ,QQVEUXFN

Data management: +HLQ] $SSR\HU ,7 UHODWHG 6WHIDQLH *RJO $+,9&26 0DUJUHW -|FKO $*(6

Virology: (OLVDEHWK 3XFKKDPPHU 6W|FNO 9LHQQD

LKH Salzburg: $OH[DQGHU (JOH 5LFKDUG *UHLO 0LFKDHOD 6FKDFKQHU 1LQRQ 7D\ORU AKH Linz: 0DULD *HLW $QJHOD gOOLQJHU AKH Wien: 5HJLQD $LFKZDOGHU )ORULDQ %UHLWHQHFNHU $UPLQ 5LHJHU 9HURQLTXH 7RX]HDX Otto-Wagner-Hospital: 3LRWU &LFKRQ %ULJLWWH 6FKPLHG $QGUHD 6WHXHU LKH Graz West: %HUQKDUG +DDV $QGUHDV .DSSHU LKH Klagenfurt: 0DQIUHG .DQDWVFKQLJ

HIV treatment centres VLWH FRRUGLQDWLQJ SK\VLFLDQV University Hospital Innsbruck: 0DUWLQ *LVLQJHU 0DULD .LWFKHQ 0DULR 6DUFOHWWL 5REHUW =DQJHUOH

Steering committee: $OH[DQGHU (JOH 0DULD *HLW %HUQKDUG +DDV 0DQIUHG .DQDWVFKQLJ $UPLQ 5LHJHU $QGUHD 6WHXHU 5REHUW =DQJHUOH

Coordinating Centre: 8QLYHUVLW\ +RVSLWDO ,QQVEUXFN

Chair: 5REHUW =DQJHUOH ,QQVEUXFN

16. AUSTRIAN HIV COHORT STUDY GROUP

Health. Nutrition. Safety. Our Concern.

978-3-200-01898-3