engleski

Rapid antiretroviral therapy initiation in the era before universal treatment, Croatia, 2005 to 2014

Background: Croatia has a centralized system of HIV care and all patients are treated at the University Hospital for Infectious Diseases (UHID) in Zagreb. The aim of our study was to examine factors related to rapid ART initiation among persons who entered HIV care in Croatia from 2005 to 2014. Materials/methods: Included into the study were Croatian citizens/residents ≥18 years who entered HIV care and started ART at UHID. Excluded were pregnant women and those who were in care elsewhere before entering care at UHID. The follow-up ended on Dec/31/2017 (earlier if died, moved or lost to follow-up). The time from HIV diagnosis to ART initiation was categorized: up to 30 days (“rapid”), from 31 days to one year (“intermediate”), and more than one year (“delayed”). We conducted quantile regression analysis to study factors related to the time from confirmed HIV-diagnosis to ART initiation with gap in care (>1 year without follow-up) considered the major predictor variable. Results: 628 patients were included into the study with a total of 4333.0 (median per-person, 6.7 [Q1-Q3: 4.3-9.5]) years of follow-up. 91.9% (577/628) were men ; median age was 36.1 (Q1-Q3: 29.6-43.8) years. The median time from HIV- diagnosis to ART initiation was 31 days (Q1-Q3: 0.3-17.7 months). Rapid ART initiation was observed in 49.8% (313/628) patients, 21.7% (136/628) and 28.5% (179/628) had intermediate and delayed initiation, respectively. On regression analysis, calendar year of entry into care, and markers of more advanced HIV disease (higher viral load, lower CD4 cell count and clinical AIDS) were significantly associated with earlier ART initiation. A gap in care before ART initiation was significantly associated with later ART initiation at all quantiles. Gap after ART, gender, transmission risk (MSM vs not MSM), age and place of residence (Zagreb vs outside Zagreb) did not have a significant impact on time to ART initiation. Conclusions: A significant proportion of patients started ART early in Croatia in the period 2005– 2014. Early ART initiation was not associated with a subsequent gap in care whereas longer waiting for ART initiation was associated with a gap in care before ART initiation.

Antiretroviral therapy ; universal treatment ; Croatia

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