Treatment outcome trends in adult HIV-positive patients receiving antiretroviral therapy in Asia: 2003-2013

The introduction of antiretroviral treatment (ART) has allowed the once rapidly expanding HIV epidemic to slow. ART scale-up in Asia has doubled treatment coverage from 19% in 2010 to 41% in 2015. Yet, Asia is a diverse region where country differences may dictate the response to the HIV epidemic. The WHO guidelines aimed to provide universal recommendations to clinicians managing HIV-positive patients. Over time, advances in HIV research have altered these guidelines, subsequently, affecting patient outcomes. An Asian observational cohort was used to explore the patient sample and evaluate temporal trends in patient outcomes.HIV research has relied upon observational cohorts as a key epidemiological resource. However, patient sampling methods used are typically not random and may not be representative of the study population. The first empirical evidence, to my knowledge, is presented to suggest that a pseudo-random patient sample is representative of the larger study population and can reach similar conclusions for routinely ascertained endpoints. CD4 count monitoring is an integral component of HIV care, particularly in resource-limited settings where viral load monitoring is not routine. CD4 count restoration has been associated with decreased risk of death, AIDS and opportunistic infections. The findings suggested that the CD4 count response to ART was greater for those initiating ART recently, regardless of pre-ART CD4 count. Mortality trends in other regions have shown reductions over time, likely a result of newer ARV drugs and earlier ART initiation. The estimated survival probabilities were 2-3% higher for patients initiating ART in 2006-2013. Retention in care is a critical component of providing long-term HIV care, especially during ART scale-up. The findings suggest that LTFU rates have varied by the year of ART initiation, where those initiating in 2006-09 have the highest rate of LTFU compared to other time periods.Monitoring clinic population trends will be essential for identifying potential pitfalls for HIV programmes in coming years. Substantial increases in the number of patients initiating ART and attending care were found, as well as an increasing older population, greater proportions using second or third ART regimens and poor viral load monitoring