ART Initiation After Guideline Changes in HIV-Infected Adolescents and Young Adults in New York City

Charles B. Hicks, MD

The mean CD4-cell count at initiation of antiretroviral therapy increased in response to 2009 treatment guidelines recommendations.

Antiretroviral therapy (ART) guidelines have evolved to recommend earlier initiation of treatment. In December 2009, Department of Health and Human Services guidelines were changed to recommend ART initiation at higher CD4-cell counts than previously suggested (≤500 cells/mm3 vs. <350 cells/mm3). In a recent retrospective study involving adolescents and young adults (age range, 13–25) with recent HIV diagnoses, researchers examined the uptake of this recommendation at four HIV clinics in New York City. They also assessed the prevalence of transmitted drug resistance over time in this population.

Between January 2007 and June 2011, 191 (58%) of 331 patients with complete data started ART. The mean CD4-cell count at ART initiation was 261 cells/mm3 before the guidelines changed (2007–2009), compared with 363 cells/mm3 after the change (2010–2011) — a significant difference. The likelihood of ART initiation among those with CD4 counts ≥350 cells/mm3 was significantly higher in 2010–2011 than in 2007–2009 (odds ratio, 5.2; 95% confidence interval, 1.1–25.1). Among 221 patients for whom pretreatment resistance test results were available, 38 (18%) had at least one major drug-resistance mutation (most commonly, K103N). The proportion of patients with viruses with transmitted resistance was higher in 2010–2011 than in 2007–2009 (25% vs. 12%).

Citation(s):

Gagliardo C et al. A multicenter study of initiation of antiretroviral therapy and transmitted drug resistance in antiretroviral-naive adolescents and young adults with HIV in New York City. Clin Infect Dis 2014 Feb 4; [e-pub ahead of print].