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PLoS One. 2014 Feb 27;9(2):e89861. doi: 10.1371/journal.pone.0089861. eCollection 2014.

Timing of antiretroviral therapy initiation after a first AIDS-defining event: temporal changes in clinical attitudes in the ICONA cohort.

Author information

  • 1Department of Public Health, Institute of Infectious Diseases, Catholic University, Roma, Italy.
  • 2Research Department of Infection & Population Health, University College London, London, United Kingdom.
  • 3Clinical Department, National Institute for Infectious Diseases "L. Spallanzani," Roma, Italy.
  • 4Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
  • 5Department of Infectious Diseases, S. Maria Nuova IRCCS Hospital, Reggio Emilia, Italy.
  • 6Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy.
  • 7Department of Infectious Diseases, University of Bari, Bari, Italy.
  • 8Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy.
  • 9Department of Internal and Specialty Medicine, University Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
  • 10Department of Infectious Diseases, University of Sassari, Sassari, Italy.
  • 11Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani," Roma, Italy.
  • 12Department of Medicine, Surgery and Dentistry University of Milan Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy.

Abstract

BACKGROUND:

Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE.

METHODS:

All HIV+ persons diagnosed with an ADE over the 6 months prior to or after enrolment in the Icona Foundation study cohort and while ART-naive were grouped according to type of diagnosis: Those with ADE requiring medications interacting with ART [group A], those with ADE treatable only with ART [B] and other ADE [C]. Survival analysis by Kaplan-Meier was used to estimate the percentage of people starting ART, overall and after stratification for calendar period and ADE group. Multivariable Cox regression model was used to investigate association between calendar year of specific ADE and time to ART initiation.

RESULTS:

720 persons with first ADE were observed over 1996-2013 (group A, n=171; B, n=115; C, n=434). By 30 days from diagnosis, 27% (95% CI: 22-32) of those diagnosed in 1996-2000 had started ART vs. 32% (95% CI: 24-40) in 2001-2008 and 43% (95% CI: 33-47) after 2008 (log-rank p=0.001). The proportion of patients starting ART by 30 days was 13% (95% CI 7-19), 40% (95% CI: 30-50) and 38% (95% CI 33-43) in ADE groups A, B and C (log-rank p=0.0001). After adjustment for potential confounders, people diagnosed after 2008 remained at increased probability of starting ART more promptly than those diagnosed in 1996-1999 (AHR 1.72 (95% CI 1.16-2.56).

CONCLUSIONS:

In our "real-life" setting, the time from ADE to ART initiation was significantly shorter in people diagnosed in more recent years, although perhaps less prompt than expected.

PMID:
24587081
[PubMed - indexed for MEDLINE]
PMCID:
PMC3937396
Free PMC Article
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