Same‐day antiretroviral therapy (ART) initiation in pregnancy is not associated with viral suppression or engagement in care: A cohort study

ObjectivesRapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings.DesignRetrospective cohort study.SettingA tertiary hospital in metropolitan Taipei, Taiwan.ParticipantsWe included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.Main outcome measuresRapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation.ResultsRapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression.ConclusionsRapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs.Ethics approvalThe study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).

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Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

AIDS Research and Therapy ◽

10.1186/s12981-020-00323-x ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Emmanuel Bahemana ◽

◽

Allahna Esber ◽

Nicole Dear ◽

Kavitha Ganesan ◽

...

Keyword(s):

Cohort Study ◽

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Cd4 Count ◽

Age Group ◽

Art Initiation ◽

Living With Hiv ◽

Over Time

Abstract Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130–547 vs. 277cells/mm3, IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

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Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

10.21203/rs.3.rs-627094/v1 ◽

2021 ◽

Author(s):

Terefe Gone Fuge ◽

George Tsourtos ◽

Emma R Miller

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Viral Suppression ◽

People Living With Hiv ◽

South Ethiopia ◽

Pharmacy Refill ◽

Living With Hiv ◽

Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

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Predictors of Delayed Antiretroviral Therapy Initiation, Mortality, and Loss to Followup in HIV Infected Patients Eligible for HIV Treatment: Data from an HIV Cohort Study in India

BioMed Research International ◽

10.1155/2013/849042 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Gerardo Alvarez-Uria ◽

Raghavakalyan Pakam ◽

Manoranjan Midde ◽

Praveen Kumar Naik

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Rural Areas ◽

Hiv Treatment ◽

Cd4 Count ◽

Sub Saharan Africa ◽

Hiv Patients ◽

Disadvantaged Community ◽

Timely Initiation ◽

Art Initiation

Studies from Sub-Saharan Africa have shown that a substantial number of HIV patients eligible for antiretroviral therapy (ART) do not start treatment. However, data from other low- or middle-income countries are scarce. In this study, we describe the outcomes of 4105 HIV patients who became ART eligible from January 2007 to November 2011 in an HIV cohort study in India. After three years of ART eligibility, 78.4% started ART, 9.3% died before ART initiation, and 10.3% were lost to followup. Diagnosis of tuberculosis, being homeless, lower CD4 count, longer duration of pre-ART care, belonging to a disadvantaged community, being widowed, and not living near a town were associated with delayed ART initiation. Diagnosis of tuberculosis, being homeless, lower CD4 count, shorter duration of pre-ART care, belonging to a disadvantaged community, illiteracy, and age >45 years were associated with mortality. Being homeless, being single, not living near a town, having a CD4 count <150 cells/μL, and shorter duration of pre-ART care were associated with loss to followup. These results highlight the need to improve the timely initiation of ART in HIV programmes in India, especially in ART eligible patients with tuberculosis, low CD4 counts, living in rural areas, or having a low socioeconomic status.

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Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

AIDS Research and Therapy ◽

10.1186/s12981-020-00319-7 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Courtney E. Sims Gomillia ◽

Kandis V. Backus ◽

James B. Brock ◽

Sandra C. Melvin ◽

Jason J. Parham ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Median Time ◽

Viral Suppression ◽

Hiv Care ◽

Virologic Suppression ◽

Community Based ◽

Art Initiation ◽

Healthcare Center ◽

The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial

Clinical Infectious Diseases ◽

10.1093/cid/ciz1126 ◽

2019 ◽

Vol 71 (10) ◽

pp. 2608-2614 ◽

Cited By ~ 3

Author(s):

Alain Amstutz ◽

Jennifer Anne Brown ◽

Isaac Ringera ◽

Josephine Muhairwe ◽

Thabo Ishmael Lejone ◽

...

Keyword(s):

Drug Resistance ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Human Immunodeficiency Virus Testing ◽

Long Term Results ◽

Absolute Difference ◽

Engagement In Care ◽

Resistance Mutations ◽

Home Based

Abstract Background The CASCADE trial showed that compared with usual care (UC), offering same-day (SD) antiretroviral therapy (ART) during home-based human immunodeficiency virus testing improved engagement in care and viral suppression 12 months after diagnosis. However, questions remain regarding long-term outcomes and the risk of propagating drug resistance. Methods After completion of the primary endpoint at 12 months, participants not in care in both arms were traced and encouraged to access care. At 24 months, the following outcomes were assessed in both arms: engagement in care, viral suppression, and reasons for nonengagement. Furthermore, we explored the acquisition of drug resistance mutations (DRMs) among SD arm nonlinkers. Results At 24 months, 64% (88/137) in the SD arm vs 59% (81/137) in the UC arm were in care (absolute difference [AD], 5%; 95% confidence interval [CI], −6 to16; P = .38) and 57% (78/137) vs 54% (74/137) had documented viral suppression (AD, 3%; 95% CI, −9 to 15; P = .28). Among 36 participants alive and not in care at 24 months with ascertained status, the majority rejected contact with the health system or were unwilling to take ART. Among 8 interviewed SD arm nonlinkers, 6 had not initiated ART upon enrollment, and no acquired DRMs were detected. Two had taken the initial 30-day ART supply and acquired DRMs. Conclusions SD ART resulted in higher rates of engagement in care and viral suppression at 12 months but not at 24 months. Leveling off between both arms was driven by linkage beyond 12 months in the UC arm. We did not observe compensatory long-term disengagement in the SD arm. These long-term results endorse SD ART initiation policies. Clinical Trials Registration NCT02692027.

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Does Rapid Initiation of Antiretroviral Therapy At HIV Diagnosis Impact On Virological Response in a Real-Life Setting? A Single Centre Experience in Northern Italy

10.21203/rs.3.rs-966688/v1 ◽

2021 ◽

Author(s):

Natalia Gregori ◽

Stefano Renzetti ◽

Ilaria Izzo ◽

Giulio Faletti ◽

Benedetta Fumarola ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Median Time ◽

Virological Response ◽

Viral Suppression ◽

Real Life ◽

Hiv Care ◽

Baseline Viral Load ◽

Hiv Diagnosis ◽

Art Initiation ◽

Late Group

Abstract Background Rapid initiation of antiretroviral therapy (ART) has been largely proven efficacious and safe mostly through clinical trials. Further investigations are needed to better define feasibility and acceptability of rapid ART approach in real-life settings. Methods We conducted a retrospective, observational study on newly HIV-diagnosed patients referred to Infectious and Tropical Diseases department of ASST Spedali Civili Hospital of Brescia from September 1st, 2015, to July 31st, 2019. All patients’ baseline characteristics were anonymously extracted from medical records. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400 day-period. The hazard ratios of each predictor on viral suppression (HIV RNA < 50 copies/ml) were estimated through Cox proportional hazard model. Results Median time from HIV diagnosis to first medical referral was 15 days and median time from first HIV care access to therapy start was 24 days. Three groups of patients were differentiated depending on ART initiation: within 7 days (rapid group, 37.6%), between 8 and 30 days (intermediate group, 20.6%) and after 30 days (late group, 41.8%). Longer time to ART start and higher baseline viral load were associated with a reduced probability of viral suppression. After one year, all groups showed high viral suppression rate (99%). Conclusions In high-income setting as Italy, rapid ART approach seems to be useful to accelerate time to viral suppression. The latter tends to be great over time regardless the timing of ART initiation.

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Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

Bulletin of the World Health Organization ◽

10.2471/blt.12.114405 ◽

2013 ◽

Vol 91 (7) ◽

pp. 491-500 ◽

Cited By ~ 17

Author(s):

Heather Bailey ◽

Claire L Townsend ◽

Igor Semenenko ◽

Ruslan Malyuta ◽

Mario Cortina-Borja ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Combination Antiretroviral Therapy ◽

Expanded Access ◽

In Pregnancy

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Assessing the impact of HIV support groups on antiretroviral therapy adherence and viral suppression in the African cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06390-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Prudence Mbah ◽

Michael Iroezindu ◽

Allahna L. Esber ◽

Nicole Dear ◽

Domonique Reed ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Support Groups ◽

Support Group ◽

Viral Suppression ◽

Hiv Care ◽

People Living With Hiv ◽

Art Adherence ◽

African Countries ◽

The Impact

Abstract Background Support groups for people living with HIV (PLWH) may improve HIV care adherence and outcomes. We assessed the impact of support group attendance on antiretroviral therapy (ART) adherence and viral suppression in four African countries. Methods The ongoing African Cohort Study (AFRICOS) enrolls participants at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Self-reported attendance of any support group meetings, self-reported ART adherence, and HIV RNA are assessed every 6 months. Logistic regression models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for support group attendance and other factors potentially associated with ART adherence and viral suppression. Results From January 2013 to December 1, 2019, 1959 ART-experienced PLWH were enrolled and 320 (16.3%) reported any support group attendance prior to enrollment. Complete ART adherence, with no missed doses in the last 30 days, was reported by 87.8% while 92.4% had viral suppression <1000copies/mL across all available visits. There was no association between support group attendance and ART adherence in unadjusted (OR 1.01, 95% CI 0.99–1.03) or adjusted analyses (aOR 1.00, 95% CI 0.98–1.02). Compared to PLWH who did not report support group attendance, those who did had similar odds of viral suppression in unadjusted (OR 0.99, 95% CI 0.978–1.01) and adjusted analyses (aOR 0.99, 95% CI 0.97–1.01). Conclusion Support group attendance was not associated with significantly improved ART adherence or viral suppression, although low support group uptake may have limited our ability to detect a statistically significant impact.

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Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: an Observational Cohort Study

10.21203/rs.3.rs-829348/v1 ◽

2021 ◽

Author(s):

Xiaoliang Zeng ◽

huanhuan chen ◽

qiuying zhu ◽

zhiyong shen ◽

guanghua lan ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Treatment Outcomes ◽

Antiviral Treatment ◽

Time Lag ◽

Cd4 Count ◽

Attrition Rate ◽

Hiv Diagnosis ◽

Cd4 Cell Count ◽

Art Initiation

Abstract Background: The number of HIV infected children receiving antiviral treatment in Guangxi is increasing. Understanding factors and trends of mortality and attrition in HIV-infected children under antiretroviral therapy (ART) was an urgently need to improve treatment outcomes. This study aimed to describe and assess mortality and attrition after ART initiation between 2004 and 2018 among children with HIV in Guangxi, China.Methods: Cohort study data were extracted from the National Free Antiretroviral Treatment Program (NFATP) database, which has standard guidelines for core treatment indicators and other data at all HIV/AIDS treatment facilities of Guangxi. A total of 901 HIV-infected children who have started ART were included in the study. The study collected the following data: age, gender, WHO clinic stages before ART, CD4 cell count before ART, Cotrimoxazole prophylaxison (CTX) use before ART, initial ART regimen, malnutrition before ART, abnormal liver function before ART, abnormal kidney function before ART, severe anemia before ART, and time lag between a HIV diagnosis and ART initiation.Results: HIV-infected children under ART had a mortality rate of 0.87 per 100 person-years, and an attrition rate of 3.02 per 100 person-years. Mortality was lower among children with CD4 count between 200-500 copies/ml (Adjusted Hazard Ratio (AHR) 0.22, 95% Confidence Interval (CI) 0.09-0.54), and CD4 count ≥500 copies/ml (AHR 0.09, 95% CI 0.03-0.27); but higher among children with late ART initiation at 1-3 months (AHR 2.37, 95% CI 1.10-5.08), and at ≥ 3 months (AHR 2.22, 95% CI 1.05-4.72). Attrition was lower among children with a CD4 count ≥500 copies/ml (AHR 0.61, 95% CI 0.40-0.93), but higher among children with late ART initiation at 1-3 months (AHR 1.63, 95% CI 1.10-2.42), and at ≥ 3 months (AHR 1.26, 95% CI 0.85-1.86).Conclusion: Supportive programs are needed to educate children’s families and parents on early ART, link HIV-infected children to care, and retain them in care among other programs that treat and manage physical conditions of HIV-infected children before ART initiation.

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