Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat'AIDS cohort.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
26
06
2019
accepted:
21
08
2019
entrez:
7
9
2019
pubmed:
7
9
2019
medline:
11
3
2020
Statut:
epublish
Résumé
Rapid antiretroviral therapy (ART) initiation has been proven beneficial for patients and the community. We aimed to analyze recent changes in timing of ART initiation in France and consequences of early start. We selected from a prospective nationwide cohort, on 12/31/2017, patients with HIV-1 infection diagnosed between 01/01/2010 and 12/31/2015. We described time from (1) diagnosis to first specialized medical encounter, (2) from this encounter to ART initiation, (3) from diagnosis to first undetectable HIV viral load (VL). We analyzed the determinants of measured temporal trends. A multivariate logistic regression was performed to assess characteristics related with 1-year retention in care. In the 7 245 included patients, median time (1) from HIV diagnosis to first medical encounter was 13 (IQR: 6-32) days, (2) to ART initiation was 27 (IQR: 9-91) days, decreasing from 42 (IQR: 13-272) days in 2010 to 18 (IQR: 7-42) in 2015 (p<0.0001), (3) to first undetectable VL was 257 (IQR: 151-496) days, decreasing from 378 (IQR: 201-810) days in 2010 to 169 (IQR: 97-281) in 2015. After one year, proportion of patients alive and still in care was significantly lower in those in the lower quartile of time from first encounter to ART (<9 days) than those in the higher quartile (>90 days), 79.9% and 85.2%, respectively (p<0.0001). In a country with unrestricted rapid access to ART, keeping recently diagnosed HIV infected patients in care remains challenging. Starting ART rapidly did not seem to be profitable for all and every patient.
Sections du résumé
BACKGROUND
Rapid antiretroviral therapy (ART) initiation has been proven beneficial for patients and the community. We aimed to analyze recent changes in timing of ART initiation in France and consequences of early start.
METHODS
We selected from a prospective nationwide cohort, on 12/31/2017, patients with HIV-1 infection diagnosed between 01/01/2010 and 12/31/2015. We described time from (1) diagnosis to first specialized medical encounter, (2) from this encounter to ART initiation, (3) from diagnosis to first undetectable HIV viral load (VL). We analyzed the determinants of measured temporal trends. A multivariate logistic regression was performed to assess characteristics related with 1-year retention in care.
RESULTS
In the 7 245 included patients, median time (1) from HIV diagnosis to first medical encounter was 13 (IQR: 6-32) days, (2) to ART initiation was 27 (IQR: 9-91) days, decreasing from 42 (IQR: 13-272) days in 2010 to 18 (IQR: 7-42) in 2015 (p<0.0001), (3) to first undetectable VL was 257 (IQR: 151-496) days, decreasing from 378 (IQR: 201-810) days in 2010 to 169 (IQR: 97-281) in 2015. After one year, proportion of patients alive and still in care was significantly lower in those in the lower quartile of time from first encounter to ART (<9 days) than those in the higher quartile (>90 days), 79.9% and 85.2%, respectively (p<0.0001).
CONCLUSIONS
In a country with unrestricted rapid access to ART, keeping recently diagnosed HIV infected patients in care remains challenging. Starting ART rapidly did not seem to be profitable for all and every patient.
Identifiants
pubmed: 31490985
doi: 10.1371/journal.pone.0222067
pii: PONE-D-19-18078
pmc: PMC6730866
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0222067Déclaration de conflit d'intérêts
The authors have declared that no competing interest exist.
Références
Prev Med. 2001 Nov;33(5):470-5
pubmed: 11676589
PLoS One. 2009;4(5):e5575
pubmed: 19440326
HIV Clin Trials. 2009 Sep-Oct;10(5):299-305
pubmed: 19906622
N Engl J Med. 2015 Aug 27;373(9):795-807
pubmed: 26192873
N Engl J Med. 2015 Aug 27;373(9):808-22
pubmed: 26193126
Epidemiol Infect. 2016 Aug;144(11):2363-70
pubmed: 27033595
J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):44-51
pubmed: 27434707
PLoS Med. 2017 Jul 25;14(7):e1002357
pubmed: 28742880
HIV Med. 2018 Mar;19(3):238-242
pubmed: 28834136
Clin Infect Dis. 2018 Feb 10;66(5):727-734
pubmed: 29069362
Clin Infect Dis. 2018 Mar 19;66(7):1027-1034
pubmed: 29099913
AIDS. 2018 Jan 2;32(1):17-23
pubmed: 29112073
HIV Med. 2018 Mar;19(3):184-194
pubmed: 29230953
Lancet HIV. 2018 Apr;5(4):e172-e180
pubmed: 29352723
Clin Infect Dis. 2019 Jan 1;68(1):43-50
pubmed: 29771296
JAMA. 2018 Jul 24;320(4):379-396
pubmed: 30043070
Clin Infect Dis. 2019 Feb 15;68(5):795-802
pubmed: 30169624
J HIV AIDS Soc Serv. 2018;17(3):163-179
pubmed: 30505245
HIV Med. 2019 Feb;20(2):175-181
pubmed: 30506853