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Implementation and effectiveness of antiretroviral therapy in Greenland.

Lohse N, Ladefoged K, Obel N - Emerging Infect. Dis. (2008)

Bottom Line: Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark.However, implementation and quality of care improved considerably in recent years.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Arhus University Hospital, Arhus, Denmark. nl@dce.au.dk

ABSTRACT
Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark. However, implementation and quality of care improved considerably in recent years.

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Proportion of patients receiving treatment on January 1, 1996–2006 in A) Denmark and B) Greenland. Numerator, patients who were receiving antiretroviral therapy as part of a HAART (highly active antiretroviral therapy) regimen. Denominator, all patients under observation. NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
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Figure 1: Proportion of patients receiving treatment on January 1, 1996–2006 in A) Denmark and B) Greenland. Numerator, patients who were receiving antiretroviral therapy as part of a HAART (highly active antiretroviral therapy) regimen. Denominator, all patients under observation. NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.

Mentions: In Greenland only 3% had begun HAART on January 1, 1997, as opposed to 28% in Denmark (Figure 1). The proportion on HAART increased gradually up to 81% in 2006, but not until 2003 did the proportion in Greenland reach the level in Denmark. Further, as late as 2001, 96% of all treatment regimens in Greenland included an unboosted PI (26% in Denmark), and in 2002 only 7% were NNRTI based (40% in Denmark). At that time the International AIDS Society USA guidelines carefully encouraged the use of boosted PIs, and NNRTI-based regimens were considered an equally effective alternative to PI-based regimens (5). Only after 2002 did the pattern shift, and in 2006 it was similar to that in Denmark, with approximately half of the combinations being NNRTI based, the other half PI based, with ritonavir-boosted lopinavir used in 65% of all PI regimens on January 1. The newer PI atazanavir was used in only 9% of PI regimens in 2006 (28% in Denmark). NNRTI used in Greenland has almost exclusively been efavirenz, whereas in Denmark 24% of NNRTI use on January 1, 2006, was nevirapine. The difference between the curves “ever on HAART” and “currently on HAART” in Figure 1 reflects the number of persons currently interrupting their treatment; the proportion with interruption is higher in Greenland than in Denmark. Structured treatment interruptions have not been recommended in Greenland or Denmark, so these persons supposedly have interrupted their therapy because of compliance problems. There was no difference in the uptake of HAART between Nuuk and the remote districts in Greenland (data not shown).


Implementation and effectiveness of antiretroviral therapy in Greenland.

Lohse N, Ladefoged K, Obel N - Emerging Infect. Dis. (2008)

Proportion of patients receiving treatment on January 1, 1996–2006 in A) Denmark and B) Greenland. Numerator, patients who were receiving antiretroviral therapy as part of a HAART (highly active antiretroviral therapy) regimen. Denominator, all patients under observation. NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2600136&req=5

Figure 1: Proportion of patients receiving treatment on January 1, 1996–2006 in A) Denmark and B) Greenland. Numerator, patients who were receiving antiretroviral therapy as part of a HAART (highly active antiretroviral therapy) regimen. Denominator, all patients under observation. NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
Mentions: In Greenland only 3% had begun HAART on January 1, 1997, as opposed to 28% in Denmark (Figure 1). The proportion on HAART increased gradually up to 81% in 2006, but not until 2003 did the proportion in Greenland reach the level in Denmark. Further, as late as 2001, 96% of all treatment regimens in Greenland included an unboosted PI (26% in Denmark), and in 2002 only 7% were NNRTI based (40% in Denmark). At that time the International AIDS Society USA guidelines carefully encouraged the use of boosted PIs, and NNRTI-based regimens were considered an equally effective alternative to PI-based regimens (5). Only after 2002 did the pattern shift, and in 2006 it was similar to that in Denmark, with approximately half of the combinations being NNRTI based, the other half PI based, with ritonavir-boosted lopinavir used in 65% of all PI regimens on January 1. The newer PI atazanavir was used in only 9% of PI regimens in 2006 (28% in Denmark). NNRTI used in Greenland has almost exclusively been efavirenz, whereas in Denmark 24% of NNRTI use on January 1, 2006, was nevirapine. The difference between the curves “ever on HAART” and “currently on HAART” in Figure 1 reflects the number of persons currently interrupting their treatment; the proportion with interruption is higher in Greenland than in Denmark. Structured treatment interruptions have not been recommended in Greenland or Denmark, so these persons supposedly have interrupted their therapy because of compliance problems. There was no difference in the uptake of HAART between Nuuk and the remote districts in Greenland (data not shown).

Bottom Line: Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark.However, implementation and quality of care improved considerably in recent years.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Arhus University Hospital, Arhus, Denmark. nl@dce.au.dk

ABSTRACT
Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark. However, implementation and quality of care improved considerably in recent years.

Show MeSH