CLINICAL AND EPIDEMIOLOGICAL STUDY Clinical course and quality of care in ART-naı ¨ve patients newly presenting in a HIV outpatient clinic M. Platten • R. Linnemann • T. Ku ¨ mmerle • N. Jung • C. Wyen • K. Ehren • S. Gravemann • D. Gillor • O. A. Cornely • J. Fischer • C. Lehmann • J. K. Rockstroh • G. Fa ¨tkenheuer • J. J. Vehreschild Received: 6 May 2014 / Accepted: 9 June 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Objectives Little data exist about the quality of care for HIV-infected subjects in Germany. We investigated the clinical course of HIV-infected subjects newly presenting in our HIV outpatient clinic. Methods Antiretroviral therapy (ART)-naı ¨ve HIV-infec- ted subjects presenting between 2007 and 2008 were fol- lowed until June 2012. Clinical data and laboratory parameters were collected prospectively and analysed retrospectively. Results From 281 subjects included, 34 patients (12 %) were lost to follow-up. 247 subjects remained, and 171 patients were followed for 1,497 days [1,121/1,726] (all data: median [interquartile range]). ART was started in 199 patients (81 %) 182 days [44/849] after HIV diagnosis, and all patients were treated according to European guidelines or within clinical trials. The CD4 cell count at first pre- sentation was 320/lL [160/500] and declined to 210/lL [100/300] at ART start. 12 months thereafter, the CD4 cell count increased to 410/lL [230/545]. The HIV RNA was suppressed below 50 copies/mL after 108 days [63/173] in 182 patients (91 %). Initial ART was changed in 71 patients (36 %) after 281 days [99/718], in five patients (7 %) due to virological failure, in 66 patients (93 %) due to other reasons, e.g. side effects or patient’s request. Conclusion Two-thirds of the included patients were followed for more than 3 years, and ART was initiated in 81 % of the patients leading to complete virological sup- pression in most patients. Compliance of physicians with treatment guidelines was high. Late presentation with a severely compromised immune function remains a problem and impairs the otherwise good prognosis of HIV infection. Keywords HIV Á Quality of care Á Antiretroviral therapy Introduction More than 20 antiretroviral drugs or drug combinations have been introduced into clinical practice over the last two decades, and combination antiretroviral therapy (ART) has led to a significant reduction of morbidity and mortality in HIV-infected individuals [1–3]. Accordingly, clinical guidelines have evolved over time, recommending an increasing number of drugs and drug combinations [4–7]. Guidelines and clinical practice may differ from country to country, mostly due to different socio-economic systems and differences in resources. Among the most intensively debated issues in the management of ART-naı ¨ve patients are the questions of when to start treatment in asymptom- atic subjects and which drugs to start with. For German care providers, the national German–Austrian guidelines and the European treatment guidelines are the most rele- vant to consider [5, 6]. M. Platten (&) Á R. Linnemann Á T. Ku ¨mmerle Á N. Jung Á C. Wyen Á K. Ehren Á S. Gravemann Á D. Gillor Á O. A. Cornely Á J. Fischer Á C. Lehmann Á G. Fa ¨tkenheuer Á J. J. Vehreschild Department of Internal Medicine I, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany e-mail: martin.platten@uk-koeln.de M. Platten Á S. Gravemann Á O. A. Cornely Á J. Fischer Á C. Lehmann Á J. K. Rockstroh Á G. Fa ¨tkenheuer Á J. J. Vehreschild German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany J. K. Rockstroh Department of Internal Medicine I, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany 123 Infection DOI 10.1007/s15010-014-0646-9