by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
June 9, 2020
Buchacz K, et al for the HIV Outpatient Study (HOPS). The HIV Outpatient Study—25 Years of HIV Patient Care and Epidemiologic Research. Open Forum Infectious Diseases – volume 7, issue 5, May 2020.https://doi.org/10.1093/ofid/ofaa123
As we pass the 39th anniversary of the report of the first cases of AIDS in the United States (MMWR, June 5th, 1981) many aspects of this disease, including its epidemiology and clinical outcomes, have significantly evolved. Several longitudinal research cohorts have been vital in providing data while monitoring progress along the HIV care continuum. This paper is from the HIV Outpatient Study (HOPS) which is a diverse cohort of HIV patients from 8 U.S. sites including Portland, Denver, Chicago, and Philadelphia. The authors looked at their key published findings since its inception in 1993. They synthesized data including trends in health outcomes (1993–2017) and mortality (1994–2017) for 10,566 patients. The HOPS has contributed to identifying new conditions (eg, lipodystrophy) and noting a significant reduction in mortality with earlier use of ART in persons with HIV. They also uncovered associations between select antiretroviral drugs and cardiovascular disease. Also, in this cohort the median CD4 cell count of participants increased from 244 cells/mm3 to 640 cells/mm3 from 1993 to 2017. In 2010, 84% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92% in 2017. The HOPS documented major declines in morbidity from opportunistic infections and a significant decline in HIV-related mortality from 121 to 16 per 1000 person-years between 1994 to 2017. These data can also be used for monitoring trends in infectious and comorbid conditions, immunologic and viral suppression status, retention in care, and survival. They are also helpful to inform progress towards “Ending the HIV Epidemic.”
Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. This database is one of several observational cohorts of persons with HIV that continue to play an important role in characterizing and defining many aspects of HIV disease. Others include the WIHS, MACS, NA-ACCORD, VACS, and D:A:D. These research groups continue to be an invaluable data source and help inform national and international guidelines for clinical practice. I wrote a piece for the HIV Specialist in 2017 describing these individual cohorts in greater detail. Below is a link to that paper.