A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

Jodie L. Guest; Amy C. Weintrob; David Rimland; Christopher Rentsch; William P. Bradley; Brian K. Agan; Vincent C. Marconi; Susan Banks; Mary Bavaro; Ionut Bebu; Helen Chun; Nancy Crum-Cianflone; Cathy Decker; Conner Eggleston; Tomas Ferguson; Susan Fraser; Joshua Hartzell; Joshua Hawley; Gunther Hsue; Arthur Johnson; Mark Kortepeter; Tahaniyat Lalani; Robbin Lockhart; Grace Macalinio; Scott Merritt; Octavio Mesner; Robert O'Connell; Maj Jason Okulicz; Sheila Peel; Michael Polis; John Powers; Roseanne Ressner; Edmund Tramont; Tyler Warkentien; Amy Weintrob; Timothy Whitman; Michael Zapor

doi:10.1371/journal.pone.0062273

A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

Jodie L. Guest, Amy C. Weintrob, David Rimland, Christopher Rentsch, William P. Bradley, Brian K. Agan, Vincent C. Marconi, Susan Banks, Mary Bavaro, Ionut Bebu, Helen Chun, Nancy Crum-Cianflone, Cathy Decker, Conner Eggleston, Tomas Ferguson, Susan Fraser, Joshua Hartzell, Joshua Hawley, Gunther Hsue, Arthur JohnsonMark Kortepeter, Tahaniyat Lalani, Robbin Lockhart, Grace Macalinio, Scott Merritt, Octavio Mesner, Robert O'Connell, Maj Jason Okulicz, Sheila Peel, Michael Polis, John Powers, Roseanne Ressner, Edmund Tramont, Tyler Warkentien, Amy Weintrob, Timothy Whitman, Michael Zapor

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

Original language	English
Article number	e62273
Journal	PLoS ONE
Volume	8
Issue number	5
DOIs	https://doi.org/10.1371/journal.pone.0062273
State	Published - 1 May 2013
Externally published	Yes

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Guest, J. L., Weintrob, A. C., Rimland, D., Rentsch, C., Bradley, W. P., Agan, B. K., Marconi, V. C., Banks, S., Bavaro, M., Bebu, I., Chun, H., Crum-Cianflone, N., Decker, C., Eggleston, C., Ferguson, T., Fraser, S., Hartzell, J., Hawley, J., Hsue, G., ... Zapor, M. (2013). A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS). PLoS ONE, 8(5), Article e62273. https://doi.org/10.1371/journal.pone.0062273

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title = "A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)",

abstract = "Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.",

author = "Guest, {Jodie L.} and Weintrob, {Amy C.} and David Rimland and Christopher Rentsch and Bradley, {William P.} and Agan, {Brian K.} and Marconi, {Vincent C.} and Susan Banks and Mary Bavaro and Ionut Bebu and Helen Chun and Nancy Crum-Cianflone and Cathy Decker and Conner Eggleston and Tomas Ferguson and Susan Fraser and Joshua Hartzell and Joshua Hawley and Gunther Hsue and Arthur Johnson and Mark Kortepeter and Tahaniyat Lalani and Robbin Lockhart and Grace Macalinio and Scott Merritt and Octavio Mesner and Robert O'Connell and Okulicz, {Maj Jason} and Sheila Peel and Michael Polis and John Powers and Roseanne Ressner and Edmund Tramont and Tyler Warkentien and Amy Weintrob and Timothy Whitman and Michael Zapor",

year = "2013",

month = may,

day = "1",

doi = "10.1371/journal.pone.0062273",

language = "English",

volume = "8",

journal = "PLoS ONE",

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Guest, JL, Weintrob, AC, Rimland, D, Rentsch, C, Bradley, WP, Agan, BK, Marconi, VC, Banks, S, Bavaro, M, Bebu, I, Chun, H, Crum-Cianflone, N, Decker, C, Eggleston, C, Ferguson, T, Fraser, S, Hartzell, J, Hawley, J, Hsue, G, Johnson, A, Kortepeter, M , Lalani, T, Lockhart, R, Macalinio, G, Merritt, S, Mesner, O, O'Connell, R, Okulicz, MJ, Peel, S, Polis, M, Powers, J, Ressner, R, Tramont, E, Warkentien, T, Weintrob, A, Whitman, T & Zapor, M 2013, 'A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)', PLoS ONE, vol. 8, no. 5, e62273. https://doi.org/10.1371/journal.pone.0062273

TY - JOUR

T1 - A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

AU - Guest, Jodie L.

AU - Weintrob, Amy C.

AU - Rimland, David

AU - Rentsch, Christopher

AU - Bradley, William P.

AU - Agan, Brian K.

AU - Marconi, Vincent C.

AU - Banks, Susan

AU - Bavaro, Mary

AU - Bebu, Ionut

AU - Chun, Helen

AU - Crum-Cianflone, Nancy

AU - Decker, Cathy

AU - Eggleston, Conner

AU - Ferguson, Tomas

AU - Fraser, Susan

AU - Hartzell, Joshua

AU - Hawley, Joshua

AU - Hsue, Gunther

AU - Johnson, Arthur

AU - Kortepeter, Mark

AU - Lalani, Tahaniyat

AU - Lockhart, Robbin

AU - Macalinio, Grace

AU - Merritt, Scott

AU - Mesner, Octavio

AU - O'Connell, Robert

AU - Okulicz, Maj Jason

AU - Peel, Sheila

AU - Polis, Michael

AU - Powers, John

AU - Ressner, Roseanne

AU - Tramont, Edmund

AU - Warkentien, Tyler

AU - Weintrob, Amy

AU - Whitman, Timothy

AU - Zapor, Michael

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

AB - Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

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U2 - 10.1371/journal.pone.0062273

DO - 10.1371/journal.pone.0062273

M3 - Article

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AN - SCOPUS:84877033611

SN - 1932-6203

VL - 8

JO - PLoS ONE

JF - PLoS ONE

IS - 5

M1 - e62273

ER -

A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

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