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Eligibility for the initiation of HIV treatment in the context of the updated EACS guidelines: results of a clinical audit

  • MC Aichelburg1,
  • M Schlag2 and
  • A Rieger1
Journal of the International AIDS Society201013(Suppl 4):P22

https://doi.org/10.1186/1758-2652-13-S4-P22

Published: 8 November 2010

Keywords

Additional Risk FactorClinical AuditRegular ObservationPrevious RecommendationCell Decline

Background

Based on the recent update (November 2009) of the European AIDS Clinical Society (EACS) guidelines for HIV-1-infected patients, initiation of antiretroviral therapy (ART) is now also recommended in patients with 350 to 500 CD4+ T cells/µl and additional risk factors.

Methods

In this single-center audit all ART-naïve HIV-1-infected subjects were screened for their eligibility to start ART based on CDC stage of disease, CD4+ T cell count and EACS-defined risk factors to assess the impact of implementing the new recommendations on clinical practice.

Results

In January 2010, 155 out of a total of 994 HIV-1-infected subjects (16%) under regular observation at the HIV outpatient clinic of the Vienna General Hospital were ART-naïve.

47.7% (74/155) of individuals had at least one EACS-defined risk factor. Immediate initiation of ART was indicated in 10 subjects with symptomatic HIV-disease (6.5%). Of the remaining 145 asymptomatic patients, 15 (10.3%) had two consecutive CD4+ T cell counts < 350/µl and 19 subjects (13.1%) with a CD4+ T cell count 350-500/µl had ≥ 1 EACS-defined risk factor. Of the latter 19 subjects, six had HBV and/or HCV co-infection and one patient was suffering from HIV-associated nephropathy, whereas the remaining 12 subjects had other risk factors, e.g. age > 50 years, HIV-1 RNA level > 100000 copies/ml and/or CD4+ T cell decline > 100/µl within 1 year. Thus, according to the current EACS guidelines initiation of ART was recommended in 20% (31/155) and should be considered in additional 8% (12/155) of treatment-naïve patients. In contrast, treatment would have been recommended in only 16% of patients (25/155) based on the previous version of the EACS guidelines.

Conclusions

In this clinical audit more than 1/4 of all treatment-naïve patients were eligible for the initiation of ART based on the updated EACS guidelines representing an increase of 76% over previous recommendations due to the inclusion of patients so far not considered eligible. Unless further studies show that ART initiation would be beneficial in all patients with a CD4+ T cell count <500/µl, awareness for HIV-associated and non HIV-risk factors needs to be increased to identify patients for whom treatment is recommended.

Authors’ Affiliations

(1)
Medical University of Vienna, Vienna, Austria
(2)
Gilead Sciences, Vienna, Austria

Copyright

© Aichelburg et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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