Naslov
Starting antiretroviral therapy for HIV at the first visit and early after inclusion into care: an observational study

Autori
Begovac, Josip ; Zekan, Šime ; Židovec Lepej, Snježana ; Lukas, Davorka

Izvornik
Journal of the International AIDS Society (1758-2652) 19 (2016), Suppl. 7; P124-P124

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
HIV, therapy, first visit

Sažetak
Introduction: Croatia has a centralized system of care and all HIV infected persons are treated at the University Hospital of Infectious Diseases (UHID) in Zagreb. All patients collect antiretroviral drugs from the hospital pharmacy at UHID. The centre at UHID is also the only centre in Croatia that provides psychosocial and adherence support to people living with HIV. Data on ART initiation at first clinic visit are limited [1, 2].We describe the characteristics of patients who start ART immediately and early after inclusion into care at UHID, and examine whether starting ART on the first visit (same-day starters) is equally successful as starting ART within the next 30 days (early starters). Materials and methods: We included ART-naı¨ve individuals aged 18 years or older, who entered care between January 2005 and December 2014 and started ART within 30 days of inclusion into care. Excluded were pregnant women and persons who were in HIV care elsewhere before entering care at UHID. We abstracted data from the electronic database. When ART was prescribed at the physician-patient visit the exact date of when ART was taken was recorded on the first follow-up visit. The primary outcome of the study was time to HIV1 RNA viral load B50 copies/mL, which was assessed by survival analysis. We also examined factors related to first visit ART initiation by logistic regression analysis. Results:We studied 378 patients whomet the eligibility criteria of whom 123 (32.5%) received ART at the first visit at UHID (Table 1). The median time of initiation of ART in the group of early starters was 5 (Q1-Q3, 2-14) days. By 12 months, the probability of achieving an HIV1 RNA viral load <50 copies/mL was 87.7% (95% CI 81.0-92.9%) and 89.3% (95% CI, 85.0-92.8%) in the same-day starters versus early starters, respectively (Figure 1). On multivariable analysis, the following factors were related to starting ART at the first visit: not having clinical AIDS (OR 2.96 ; 95% CI 1.77-4.94), a CD4 cell count £350/mm3 (OR 4.28 ; 95% CI 1.88-9.72), being MSM (OR 2.65 ; 95% CI 1.51-4.67), receiving 2NRT+1PI (OR 1.92 ; 95% CI 1.17-3.14) and being integrated into care after 30 days (OR 2.63 ; 95% CI 1.37-5.08). Conclusions: In this HIV-infected patient population with predominantly advanced immunosuppression at entry into care, same-day ART was as successful as therapy given within 1 month after the first physician-patient visit. References: 1. Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016 ; 13:e1002015. doi: http://dx.doi.org/10.1371/journal.pmed.1002015 2. Pilcher CD, Hatano HH, Dasgupta A, Jones D, Torres S, Calderon F, et al. Providing same day, observed ART to newly diagnosed HIV outpatients is associated with improved virologic suppression. [Abstract WEAD0105 LB.] 8th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2015) ; Jul 19 22 ; Vancouver, Canada.

Izvorni jezik
Engleski

POVEZANOST RADA