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Title
HIV treatment outcomes after 10 years on ART in the TREAT Asia Observational Database (TAHOD) and Australian HIV Observational Database (AHOD)
Presenter
Awachana Jiamsakul
Authors
A. Jiamsakul1, D. Rupasinghe1, I. Woolley2, J.Y. Choi3, D.J. Templeton1,4, A. Widhani5, K. Petoumenos1, J. Tanuma6, TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD) of IeDEA Asia-Pacific
Institutions
1The Kirby Insitute, UNSW Sydney, New South Wales, Australia, 2Monash Infectious Diseases, Monash Health, and Monash University, Clayton, Australia, 3Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of, 4The University of Sydney, Department of Sexual Health Medicine, Sydney Local Health District, and Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, Sydney, Australia, 5Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, 6National Center for Global Health and Medicine, Tokyo, Japan

BACKGROUND: An increasing number of people living with HIV (PLHIV) have been receiving antiretroviral therapy (ART) for many years. This study aimed to assess immunological and survival outcomes among PLHIV from Asia and Australia who have been on ART for at least a decade.
METHODS: PLHIV enrolled in TAHOD and AHOD, and on ART for at least 10 years, were included. Factors associated with CD4 cell counts during years 11 to 15 post ART initiation were analysed using repeated measure linear regression. Survival after 10 years on ART was analysed using Fine and Gray competing risk regression.
RESULTS: We included 4867 PLHIV from TAHOD and 2272 from AHOD. There were 3345 males (69%) in TAHOD, and 2110 (93%) in AHOD. The median lowest post-ART CD4 counts in the first decade was 178 cells/µL (IQR 92-287) for TAHOD and 250 cells/µL (IQR 140-374) for AHOD. Higher CD4 counts after 10 years were observed when the lowest CD4 levels were higher (101-200 cells/µL: difference= 35, 95%CI 18, 51; and >200 cells/µL: difference=125, 95%CI 107, 142) compared to CD4 =50 cells/µL, and in those who had achieved CD4 =500 cells/µL (achieved =500 cells/µL then decreased to <500 cells/µL: difference=225, 95%CI 213, 236; and always =500 cells/µL: difference=402, 95%CI 384, 420) compared to CD4 counts always <500 cells/µL in the previous decade. Prior PI-based regimen (difference=-17, 95%CI -33, -1) compared to no PI, and previous treatment interruptions (TI) of 14 days to 3 months and >6 months were associated with lower CD4 counts after 10 years (difference = -38, 95%CI -62, -15; and difference=-44, 95%CI -61, -27, respectively) compared to no TI. Other factors associated with low CD4 counts were older age, higher viral load, hepatitis B/C co-infection, differing ART regimens, World Bank country income grouping and follow-up time. There was a total of 405 deaths (6%) after 10 years, with a mortality rate of 1.04 per 100 person-years. Controlling for confounders, females had better survival compared to males (sub-hazard ratio=0.65, 95%CI 0.46, 0.91).
CONCLUSIONS: Sustaining high CD4 levels and minimising TI have far-reaching benefits well beyond the first decade of ART.

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