This thesis presents a series of longitudinal studies of HIV-outcomes in Australia and the Asia-Pacific region since highly active antiretroviral therapy (HAART) became available. The primary source of data is the Australian HIV Observational Database (AHOD). AHOD is an observational cohort of more than 2000 patients with HIV recruited via hospitals, sexual health centres and general medical practices specialising in HIV medicine. Chapter five of this thesis addresses whether there were any differences in antiretroviral therapy use and virological response that might explain the different trends in new HIV diagnosis rates between state jurisdictions in Australia in recent years. Analysis of data from cohort studies of primary and chronic HIV infection, gay community surveys and national prescription data suggest that, for the most part, antiretroviral therapy use and virological response were similar in each jurisdiction during the first decade of HAART. Chapter six describes the prevalence of, and risk factors for, an incomplete immune response despite sustained viral suppression in patients on HAART in AHOD. The clinical relevance of this phenomenon is also explored in terms of AIDS and death during follow-up. Of those with sustained viral suppression, one third of patients did not achieve immune recovery greater than 350 cells/??l in the 12-24 months after starting their first or second HAART regimen, and this was associated with a lower CD4 cell count at baseline. Chapter seven describes cause-specific mortality in patients with HIV in the Asia-Pacific region. Immunodeficiency was associated with non-AIDS and AIDS mortality, and the risk of non-AIDS mortality increased with age. Less conclusive was the relationship between country-income level and risk of death from AIDS or non-AIDS causes because of the relatively high proportion of unknown causes of death in low-income settings. Chapter eight presents hospitalisation rates, risk factors and associated diagnoses in patients with HIV in Australia. Older, sicker individuals, as indicated by markers of advanced immunodeficiency or frequency of hospitalisation, were at greater risk of hospitalisation and death in the AHOD cohort. Despite effective antiretroviral therapy, patients with HIV are currently hospitalised at higher rates than people of similar age in the general population.
| Identifer | oai:union.ndltd.org:ADTP/272623 |
| Date | January 2009 |
| Creators | Falster, Kathleen Anne, National Centre in HIV Epidemiology & Clinical Research, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. National Centre in HIV Epidemiology & Clinical Research |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Falster Kathleen Anne., http://unsworks.unsw.edu.au/copyright |
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