The Australian HIV Observational Database (AHOD)

The challenge

With the advances in antiretroviral therapy (ART), people with HIV now have life expectancies comparable to those of general population. 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 people with HIV. Even in the current era of highly tolerable and highly effective ART, ongoing monitoring remains important. As the cohort ages, aging-related comorbidities are becoming increasingly common in people with HIV. AHOD is the largest, and longest running, data source in Australia monitoring the uptake and impact of HIV treatment and burden comorbidities over time.

The project

AHOD is an observational cohort study of more than 4,000 people with HIV 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. Since the renewed funding cycle commencing in 2022, there are now 17 currently active sites in AHOD (sites from NSW, VIC, NT and QLD only).

The method

AHOD includes people with HIV 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 had ever participated 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 people with HIV. AHOD has described the changing spectrum of causes of death, and patterns of long term immunological and virological response among treated individuals. Over the past 25 years, AHOD has demonstrated incremental improvements in virological response for participants 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 people with HIV 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. Moreover, AHOD data also contributed to RESPOND: The International Cohort Consortium of Infectious Disease and Outcomes of Antiretroviral Treatment, a prospective multi-cohort collaboration from across Europe and Australia designed to address HIV treatment related outcomes in more than 36,000 people living with HIV from 11 cohorts in Europe and Australia.

Project collaborators

Current Project Collaborators
•    Cairns Sexual Health Service - Cairns North, Queensland
•    Centre for Disease Control - Darwin, Northern Territory
•    Sunshine Coast Hospital and Health Service, Nambour hospital - Nambour, Queensland
•    East Sydney Doctors – Darlinghurst, New South Wales
•    Gold Coast Hospital and Health Service – Southport, Queensland
•    HNE Sexual Health – Tamworth, New South Wales
•    Holdsworth House Medical Practice – Sydney, New South Wales
•    Mid North Coast LHD – Lismore, New South Wales
•    Melbourne Sexual Health Centre – Carlton, Victoria
•    Monash Medical Centre – Clayton, Victoria
•    Prahran Market Clinic – Prahran, Victoria
•    Royal Prince Alfred Sexual Health – Camperdown, New South Wales
•    Sexual Health and HIV Service in Metro North – Brisbane, Queensland
•    St Vincent's Hospital – Darlinghurst, New South Wales
•    Taylor Square Private Clinic – Darlinghurst, New South Wales
•    The Alfred Hospital – Melbourne, Victoria
•    Western Sydney Sexual Health Centre – Parramatta, New South Wales

Past Project Collaborators
•    Blue Mountains Sexual Health - Katoomba, New South Wales
•    The Albion Centre - Sydney, New South Wales
•    Illawarra Sexual Health - Warrawong, New South Wales
•    Nepean Sexual Health Centre - Penrith, New South Wales
•    Holden Street Clinic - Gosford, New South Wales
•    Sydney Sexual Health Centre - Sydney, New South Wales
•    Dr Ellis GMP, Coffs Harbour - Coffs Harbour, New South Wales
•    O’Brien Street Practice - Adelaide, South Australia
•    Gladstone Road Medical Centre - Highgate Hill, Queensland
•    Northside Clinic - North Fitzroy, Victoria
•    Royal Perth Hospital - Perth, Western Australia
•    Waikato Hospital – Hamilton, New Zealand
•    Wellington Hospital – Wellington, New Zealand