The role of observational data in monitoring trends in antiretroviral treatment and HIV disease stage - Results from the Australian HIV observational database

Objectives: To illustrate how human immunodeficieny virus (HIV) observational databases may be used to monitor trends in HIV treatment and HIV disease outcomes through data reported from the Australian HIV Observational Database (AHOD). Methods: Time trends in the use of antiretroviral treatment, and changes in treatment strategies were calculated in patients recruited to AHOD from HIV specialist clinics including hospitals, sexual health clinics and general practices. These results were then compared to trends reported from other observational cohorts. Results: By September 2001, 1961 patients were recruited to AHOD. Since entering AHOD, 3% of patients have been diagnosed with an AIDS Mining illness, and 2% of patients have died, of which, 54% were non-HIV related deaths. The proportion of patients receiving antiretroviral therapy increased from 66% between January and June 1998 and 77% between July and September 2001. The most commonly received treatment regimen was triple therapy including a protease inhibitor (PI), ranging between 36% in January and June 1998 and 31% in July to September 2001. Triple therapy including a non-nucleoside reverse transcriptase inhibitor (NNRTI) more than doubled to 32% between July and September 2001. The proportion of patients receiving either stavudine (d4T) or zidovudine (AZT) treatment regimens decreased from 92% between January and June 1998 to 76% between July and September 2001. Patients receiving ritonavir in combination with another PI increased, as did the proportion of patients interrupting therapy for more than 3 months. Conclusion: These findings suggest there have been changes in the way antiretroviral treatments have been used in Australia, and are consistent with the current literature. Furthermore, these findings demonstrate the usefulness of observational cohorts as a surveillance tool monitoring trends in treatment and disease progression. (C) 2002 Elsevier Science B.V. All rights reserved.