LI may be due to late HIV diagnosis or late cART initiation, and an assessment of LI causes and barriers to early initiation is necessary. Although LI is prevalent in the Asia–Pacific region, Canada, South America, and sub-Saharan Africa, how the causes of LI have changed in response to the implementation of various HIV policies has not been comprehensively explored. LI has been associated with inflammation and metabolic abnormalities, increased 48-week mortality, HIV transmission to sexual partners, virological failure-induced regimen modification, and decreased life expectancy.
Īmong PLWH, late initiation (LI) of cART is defined as having a CD4 + count of < 200 cells/μL or an AIDS-defining disease at cART initiation. Nevertheless, a substantial proportion of patients begin cART with an advanced HIV status.
#Rapidcart 3 upgrade
Several strategies have been implemented sequentially to upgrade HIV treatment outcomes (including the following recommended CD4 + count thresholds at cART initiation: ≤ 350 cells/µL in 2008, ≤ 500 cells/µL in 2010, and all patients with HIV regardless of CD4 + count in 2015 ) to increase global cART coverage (48% in 2015, 53% in 2016, and 59% in 2017). cART has considerably decreased AIDS-related morbidity and mortality in PLWH. Potent combination antiretroviral therapy (cART) can suppress HIV loads to an undetectable level and restore CD4 + T-cell counts in people living with HIV (PLWH). Policymakers should implement strategies to facilitate earlier HIV diagnosis among older populations and improve access to cART among people with newly diagnosed acute HIV infection. In addition to HIV diagnosis during 2009–2012, we identified acute HIV infection and an age over 30 years as risk factors for LI without LP and LI with LP, respectively. Moreover, we identified late presentation (LP) of HIV as the consistent main etiology of LI during the 11-year study period. This multicenter retrospective cohort study investigated the trends, joinpoints, and etiologies of LI of cART during 2009−2019, explored the determinants of various statuses at cART initiation, and evaluated the effects of these statuses on all-cause mortality among newly diagnosed patients living with HIV.Īlthough the LI proportion improved significantly from 2009 to 2015, we identified a slow increasing trend between 20. Given the rise in LI from 2015 in the era of treat-all and rapid cART initiation, strategic interventions to increase earlier cART initiation must be intensified in Taiwan, especially among populations with delayed access to HIV testing services.Įvolving trends and etiologies of late initiation (LI) of combination antiretroviral therapy (cART), despite the implementation of various HIV policies, have not been thoroughly examined. LILP(−) and LILP(+) were associated with a higher all-cause mortality risk.
In addition to HIV diagnosis during 2009–2012, multinomial logistic regression identified an age over 30 years and acute HIV infection as risk factors for LILP(+) and LILP(−), respectively. For LI, we identified one joinpoint in 2015: a substantial decrease from 77.14% in 2009 to 34.45% in 2015, followed by a nonsignificant increase to 39.1% in 2019. The median CD4 + count at cART initiation increased significantly between 2009 (98 cells/μL) and 2015 (325 cells/μL) and stabilized thereafter ( P for trend < 0.001). Joinpoint regression was used to identify changes in LI proportion.
This multicenter retrospective cohort study enrolled 1198 patients with newly diagnosed HIV infection during 2009–2019 who were grouped by status at cART initiation: those without LI (non-LI group, 56.01%) those with LI but without late presentation (LP) of HIV (LP: a CD4 + count of < 200 cells/μL at HIV presentation or AIDS events ≤ 3 months of HIV diagnosis) and those with LI and with LP of HIV. We assessed key concerns, characterized the determinants of various statuses at cART initiation, and evaluated the effects of those statuses on all-cause mortality after cART initiation. Late initiation (LI) of combination antiretroviral therapy (cART)-defined as having a CD4 + count of < 200 cells/μL or an AIDS-defining disease at cART initiation-has detrimental outcomes but remains prevalent worldwide, with LI trends and etiologies following the implementation of various HIV policies remaining underinvestigated.
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