Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF.In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.Despite substantial progress since the introduction of highly-active antiretroviral therapy (HAART) [1-4], maintaining virologic suppression is predominantly challenged by suboptimal antiretroviral (ARV) adherence. Studies have shown that difficulty with adherence is usually associated with (1) significant barriers to care, (2) ARV intolerability and (3) individual factors such as education, treatment fatigue, and the psychosocial context of the patient [5-7].We sought to examine a large, multicenter cohort composed of military personnel and beneficiaries with HIV infection followed since diagnosis in order to illustrate the HAART outcomes for patients within a free-access healthcare system in the United State