caa a22 4500 606157859 CHVBK 20210128100616.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10096-014-2227-3 doi (NATIONALLICENCE)springer-10.1007/s10096-014-2227-3 Antiretroviral therapy initiation in an Australian cohort: implications for increased use of antiretroviral therapy [Elektronische Daten] [I. Stratov, S. Kent] Human immunodeficiency virus (HIV) management is entering a "universal test and treat” phase, although the benefits from this approach in developed world scenarios are uncertain. We analyzed 79 combination anti-retroviral therapy (cART)-naïve HIV-positive individuals who were intensively prospectively followed from 2004 to 2013. We studied HIV-related illnesses, potential HIV transmissions, impact on sexual behavior, and factors impeding earlier cART initiation. Sixty-eight (86%) subjects commenced cART at a mean of 6.0years after diagnosis: 71% with a CD4 T-cell count <350 cells/μl. A significant minority of subjects (29%) resisted initiation of cART despite physician recommendation for a mean of 18months. Only one HIV-related illness occurred in a patient who had not previously recorded a CD4 T-cell count <500 cell/μl, totaling 195 person-years of observation. A 40% increase in sexually transmitted infections (STIs) occurred after commencing cART. We detected six HIV transmissions in our cohort, all of which were before initiating cART and 5 of them had a prior CD4 T-cell count <500 cells/μl. Illnesses related to cART deferral were rare and most HIV transmissions we detected occurred in people with a prior CD4 T-cell count <500 cells/μl. Our study raises concerns about increasing STI rates after cART initiation. Focusing resources on cART initiation among patients with CD4 T-cell counts <500 cells/μl and enhancing safe sexual practices should remain a priority. Springer-Verlag Berlin Heidelberg, 2014 Stratov I. Department of Microbiology and Immunology, Peter Doherty Institute, 792 Elizabeth St., 3010, Parkville, VIC, Australia aut Kent S. Department of Microbiology and Immunology, Peter Doherty Institute, 792 Elizabeth St., 3010, Parkville, VIC, Australia aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 253-259 0934-9723 34:2<253 2015 34 10096 https://doi.org/10.1007/s10096-014-2227-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-014-2227-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Stratov I. Department of Microbiology and Immunology, Peter Doherty Institute, 792 Elizabeth St., 3010, Parkville, VIC, Australia aut NATIONALLICENCE 700 1- Kent S. Department of Microbiology and Immunology, Peter Doherty Institute, 792 Elizabeth St., 3010, Parkville, VIC, Australia aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 253-259 0934-9723 34:2<253 2015 34 10096