20th International AIDS Conference - Melbourne, Australia

Abstract

MOPE122 - Poster Exhibition


Characteristics of unselected HIV-positive patients over the last 15 years and treatment attitude: the Italian MASTER cohort

C. Torti1, E. Raffetti2, E. Focà3, N. Mazzini4, F. Donato2, F. Castelli3, F. Maggiolo5, A. Scalzini6, A. Saracino7, A. Gori8, A. Pan9, L. Sighinolfi10, F. Mazzotta11, M. Di Pietro11, R. Cauda12, Master Study Group

1University Magna Grecia of Catanzaro, Institute of Infectious Diseases, Catanzaro, Italy, 2University of Brescia, Institute of Hygiene, Epidemiology and Public Health, Brescia, Italy, 3University of Brescia, Institute of Infectious and Tropical Diseases, Brescia, Italy, 4Univesity of Brescia, Department of Engineering information, Brescia, Italy, 5Ospedali Riuniti, Bergamo, Italy, 6Spedali Civili di Brescia, Brescia, Italy, 7Policlinico di Bari, Bari, Italy, 8Ospedale S. Gerardo, Monza, Italy, 9Istituti Ospitalieri, Cremona, Italy, 10S.Anna Hospital, Ferrara, Italy, 11S. Maria Annunziata Hospital, Florence, Italy, 12Catholic University of Sacred Heart, Institute of Infectious Diseases, Rome, Italy

Background: The prospective, observational MASTER cohort is based on electronic chart for routine use in the collaborating Centers. So all HIV-positive patients presenting for care are included. This study describes baseline characteristics of patients included in the Master Cohort from Jan 1996 to Sept 2012 to give a picture of the Italian epidemics in the post-HAART era.
Methods: This is multi-center, prospective, observational study of HIV patients enrolled in the MASTER Italian Cohort from January 1996 to September 2012. Common statistical methods for the analysis of means and proportions were used. Multiple linear regression was used to estimate the change in baseline CD4 count from 1996 to 2012 adjusting for gender, age, risk factors and migrant effect.
Results: Amongst 24,300 subjects included in the MASTER Cohort, 65% (15,794) were enrolled after 1996. 9,444 (59.8%) were still actively followed-up at the end of 2012, while 1,525 (9.7%) died. Hetherogenicity among centers was demonstrated. From 1996-2001 to 2002-2007 and 2008-2012, a statistical significant decrease in HIV/HCV and/or HIV/HBV co-infected patients (from 43.6% to 31.3% and 19.6%, respectively), while an increase in males (from 71.2% to 73.7 and 73.9%, respectively) and non-EU subjects (from 8.3% to 16.1% and 21.3%, respectively) were observed. CD4 count at presentation increased from 1996 to 2012 (β: 5.4; 95% CI: 4.3-6.5, p< 0.001). Notwithstanding, patients who started ART therapy among those entered increased significantly (from 53.4% to 78.8% and 78.1%, respectively). Prescription of boosted-PI also increased (44.3%, 49.9%, 59.0%), while NNRTI containing regimens increased (from 18.1% in 1996-2001 to 38.4% in 2002-2007), and then decreased (32.9% in 2008-2012). Regimens including INSTI appeared to be prescribed in a minority (3.0%) of patients in the last period.
Conclusions: A continuous trend toward earlier HAART is ongoing in Italy with a tendency to use boosted-PI´s rather than NNRTI. Given the substantial proportion of patients lost to follow-up, programs to improve retention and a widespread collaboration between centers to track patients is needed. Lastly, since migrants account for 1:5 new patients in recent years, the implications of this effect need to be addressed from a public health perspective.

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