Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

by Kuan-Yin Lin, Chien-Yu Cheng, Chia-Wen Li, Chia-Jui Yang, Mao-Song Tsai, Chun-Eng Liu, Yuan-Ti Lee, Hung-Jen Tang, Ning-Chi Wang, Te-Yu Lin, Yi-Chien Lee, Shih-Ping Lin, Yu-Shan Huang, Jun-Yu Zhang, Wen-Chien Ko, Shu-Hsing Cheng, Chien-Ching Hung, for the Taiwan HIV Study Group

Objectives

The international and national HIV treatment guidelines in 2016 have focused on scaling up access to combination antiretroviral therapy (cART). We aimed to assess the trends and treatment outcomes of late cART initiation in Taiwan.

Methods

Between June 2012 and May 2016, we retrospectively included antiretroviral-naive HIV-positive adults who initiated cART. Late initiation was defined as when cART was initiated in patients with a CD4 count 3 or having experienced AIDS-defining illnesses. The treatment outcomes were assessed up to 6 months after starting cART.

Results

We included 3655 HIV-positive patients, and the majority of the patients were male (95.4%) with a median age of 31 years and initiated non-nucleoside reverse-transcriptase inhibitor-containing regimens (87.0%). The median CD4 count at cART initiation increased from 207 cells/mm³ in 2012 to 298 cells/mm³ in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (P for trend Conclusions

While the proportion of late cART initiation decreased over time in Taiwan, late initiation remained in a substantial proportion of HIV-positive patients. The late initiators had higher risk for poor outcomes. The need for strategies to earlier detection of HIV infection and expediting cART initiation should be highlighted, especially among the older population.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2sZS6MP
via IFTTT