The Australian HIV Observational Database (AHOD)

The challenge

HIV infection requires lifelong treatment with antiretroviral therapy (ART). In the earlier years of combination ART, although effective in managing HIV disease progression, ART was very toxic and poorly tolerated. Monitoring the impact of ART including updates to treatment, adherence, impact on HIV disease progression and overall mortality was critical to the understanding of HIV disease progression, and for providing guidance to the management and treatment of HIV patients. Even in the current era of highly tolerable and highly effective ART, ongoing monitoring remains important. AHOD is the largest, and longest running, data source in Australia monitoring the uptake and impact of HIV treatment.

The project

AHOD is an observational cohort study of more than 4,000 HIV positive patients in Australia under routine clinical care. It was established in 1999 to monitor treatment uptake and outcomes. In 2014, AHOD was expanded to include clinical sites in New Zealand. Since its inception, AHOD has provided the best available surveillance data on trends in antiretroviral treatment uptake and use in Australia and has a central role in State and Commonwealth Health Departments planning of HIV care.

The method

AHOD includes HIV-positive patients recruited via tertiary referral hospitals, specialist general practices and sexual health clinics. Approximately 30 HIV clinics throughout most states and territories in Australia and 2 sites in New Zealand participate in AHOD. AHOD participants provide informed consent for routinely recorded HIV treatment and clinical data to be collated. AHOD data are checked and aggregated by researchers in the Biostatistics and Databases Program at the Kirby Institute on behalf of collaborating sites. AHOD has a Steering Committee (SC) comprised of site investigators, community (NAPWHA) and Indigenous representation to ensure all research is scientifically rigorous.

The results

Since AHOD's inception, there have been more than 40 peer-review journal articles describing the impact of ART on outcomes in HIV-positive patients. AHOD has described the changing spectrum of causes of death, and patterns of long term immunological and virological response among treated HIV-positive patients. Over the past 15 years, AHOD has demonstrated incremental improvements in virological response for patients initiated on combination ART. Most deaths are now non-AIDS related, and data from AHOD has underscored the fact that if CD4+ counts are at a high level, life expectancy approaches that of the general population.

The impact

AHOD is a unique resource in describing the treatment environment for HIV positive people in Australia. Data from AHOD illustrate how research from clinical trials and changes in treatment guidelines is translated into routine clinical practice. AHOD data are used by State and Commonwealth Health Departments, and community organisations, to understand the current treatment status of HIV-positive patients that help guide resource decisions and clinical treatment management guidelines. Data from AHOD have also underpinned the health economic aspects of several successful submissions by pharmaceutical companies to PBAC for public funding of new antiretroviral drugs.

Project collaborators
Currently recruiting
Focus areas