CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Sexual Health   
Sexual Health
Journal Banner
  Publishing on sexual health from the widest perspective
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Structure
For Advertisers
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
For Authors
General Information
Submit Article
Author Instructions
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Library Recommendation

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Submit Article
blank image
Use the online submission system to send us your paper.

red arrow Connect with us
blank image
facebook twitter logo LinkedIn

red arrow Interview with Kit Fairley
blank image
Hear Kit Fairley speak about what is sexual health.


Article << Previous     |     Next >>   Contents Vol 8(3)

Triple class experience after initiation of combination antiretroviral treatment in Australia: survival and projections

Sadaf Marashi Pour A F, Ian Woolley B, Peter Canavan C, John Chuah D, Darren B. Russell E, Matthew Law A and Kathy Petoumenos A

A National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
B Monash Medical Centre and Department of Medicine Monash University, Clayton, Vic. 3168, Australia.
C National Association of People Living With HIV/AIDS, Sydney, NSW 2042, Australia.
D Gold Coast Sexual Health Clinic, Miami, Qld 4220, Australia.
E Cairns Sexual Health Service, Cairns, Qld 4870, Australia.
F Corresponding author. Email: sadaf.marashipour@doh.health.nsw.gov.au

Sexual Health 8(3) 295-303 http://dx.doi.org/10.1071/SH10008
Submitted: 29 January 2010  Accepted: 29 October 2010   Published: 23 May 2011

PDF (206 KB) $25
 Export Citation

Background: Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. Methods: Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. Results: Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200 cells μL–1 and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. Conclusion: Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.

Additional keywords: antiretroviral therapy, cohort studies, HIV, prevalence, survival analysis, trends.


[1]  Correll PK, Law MG, McDonald AM, Cooper DA, Kaldor JM. HIV disease progression in Australia in the time of combination antiretroviral therapies. Med J Aust 1998; 169: 469–72.

[2]  Law MG, Li Y, McDonald AM, Cooper DA, Kaldor JM. Estimating the population impact in Australia of improved antiretroviral treatment for HIV infection. AIDS 2000; 14: 197–201.
CrossRef |

[3]  Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338: 853–60.
CrossRef |

[4]  Carr A, Cooper DA. Adverse effects of antiretroviral therapy. Lancet 2000; 356: 1423–30.
CrossRef |

[5]  French MA. Disorders of immune reconstitution in patients with HIV infection responding to antiretroviral therapy. Curr HIV/AIDS Rep 2007; 4: 16–21.
CrossRef |

[6]  Australian HIV Observational Database. Rates of combination antiretroviral treatment change in Australia, 1997–2000. HIV Med 2002; 3: 28–36.
CrossRef |

[7]  Sabin CA, Hill T, Lampe F, Matthias R, Bhagani S, Gilson R, et al Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study. BMJ 2005; 330: 695.
CrossRef |

[8]  National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2008. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2008.

[9]  Ledergerber B, Lundgren JD, Walker AS, Sabin C, Justice A, Reiss P, et al Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes. Lancet 2004; 364: 51–62.
CrossRef |

[10]  Mocroft A, Horban A, Clotet B, d’Arminio Monforte A, Bogner JR, Aldins P, et al Regional differences in the risk of triple class failure in European patients starting combination antiretroviral therapy after 1 January 1999. HIV Med 2008; 9: 41–6.
CrossRef |

[11]  Lohse N, Obel N, Kronborg G, Laursen A, Pedersen C, Larsen CS, et al Declining risk of triple-class antiretroviral drug failure in Danish HIV-infected individuals. AIDS 2005; 19: 815–22.
CrossRef |

[12]  Mocroft A, Ledergerber B, Viard JP, Staszewski S, Murphy M, Chiesi A, et al Time to virological failure of 3 classes of antiretrovirals after initiation of highly active antiretroviral therapy: results from the EuroSIDA study group. J Infect Dis 2004; 190: 1947–56.
CrossRef |

[13]  Phillips AN, Leen C, Wilson A, Anderson J, Dunn D, Schwenk A, et al Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: an observational cohort study. Lancet 2007; 370: 1923–8.
CrossRef |

[14]  Falster K, Gelgor L, Shaik A, Zablotska I, Prestage G, Grierson J, et al Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment. Sex Health 2008; 5: 141–54.
CrossRef |

[15]  Petoumenos K, Law MG. Risk factors and causes of death in the Australian HIV Observational Database. Sex Health 2006; 3: 103–12.
CrossRef |

[16]  National Centre in HIV Epidemiology and Clinical Research. Australian HIV observational database annual report. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South; 2008.

[17]  Petoumenos K. The role of observational data in monitoring trends in antiretroviral treatment and HIV disease stage: results from the Australian HIV observational database. J Clin Virol 2003; 26: 209–22.
CrossRef |

[18]  Ockenga J, Tillmann HL, Trautwein C, Stoll M, Manns MP, Schmidt RE. Hepatitis B and C in HIV-infected patients. Prevalence and prognostic value. J Hepatol 1997; 27: 18–24.
CrossRef |

[19]  Thio CL, Seaberg EC, Skolasky R, Phair J, Visscher B, Munoz A, et al HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet 2002; 360: 1921–6.
CrossRef |

[20]  Petoumenos K, Ringland C. Antiretroviral treatment change among HIV, hepatitis B virus and hepatitis C virus co-infected patients in the Australian HIV Observational Database. HIV Med 2005; 6: 155–63.
CrossRef |

[21]  Lincoln D, Petoumenos K, Dore GJ. HIV/HBV and HIV/HCV coinfection, and outcomes following highly active antiretroviral therapy. HIV Med 2003; 4: 241–9.
CrossRef |

[22]  Glesby MJ, Hoover DR. Survivor treatment selection bias in observational studies: examples from the AIDS literature. Ann Intern Med 1996; 124: 999–1005.

Subscriber Login

Legal & Privacy | Contact Us | Help


© CSIRO 1996-2016