The proportion of patients with HIV who experienced virologic failure while receiving routine care in France declined significantly from 1997 to 2011, according to new data.
“The higher sensitivity of HIV RNA assays is leading to more aggressive and effective management of resistance,” the researchers wrote in Clinical Infectious Diseases. “New-generation antiretroviral drugs with better tolerability and a lower pill burden will likely further improve adherence to treatment. Finally, earlier treatment initiation at relatively high CD4 cell counts is likely to improve long-term virologic outcome.”
Constance Delaugerre, MD, PhD, of the Laboratoire de Virologie, Hôpital Saint-Louis in Paris, and colleagues, used data from the French Hospital Database on HIV to evaluate trends in rates of virologic failure and other factors from 1997 to 2011. The study included 81,738 patients with a median follow-up of 9.4 years, corresponding to a median of 11 viral load measures per patient.
The percentage of patients that experienced at least one viral failure during a 2-year period decreased continuously from 61.5% in 1997-1998 to 9.7% in 2009-2011 (P<.0001). The median viral load at time of viral failure also steadily declined from 7,032 copies/mL in 1997-1998 to 2,536 copies/mL in 2009-2011. Factors associated with the reduced virologic failure included recent calendar periods, higher CD4 counts, hepatitis C virus coinfection and baseline regimens of non-nucleoside reverse transcriptase inhibitors or integrase inhibitors.
The researchers said 49% of patients in other countries, including the United States, do not remain in HIV care, often due to financial issues. In France, 87% of patients with known HIV are under care, likely because all treatments are free.
“Similarly high rates of retention in care are also seen in other countries where antiretroviral treatment is provided free of charge,” the researchers wrote. “Thus, accessible and affordable health care, including new drugs and formulations, as well as close monitoring, are necessary to lower the global burden of HIV.”
Disclosure: The researchers report no relevant financial disclosures.