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

doi:10.1371/journal.pone.0179870

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Title:	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
Authors:	Lin, Kuan-Yin Cheng, Chien-Yu Li, Chia-Wen Yang, Chia-Jui Tsai, Mao-Song Liu, Chun-Eng Lee, Yuan-Ti Tang, Hung-Jen Wang, Ning-Chi Lin, Te-Yu Lee, Yi-Chien Lin, Shih-Ping Huang, Yu-Shan Zhang, Jun-Yu Ko, Wen-Chien Cheng, Shu-Hsing Hung, Chien-Ching
Contributors:	Natl Taiwan Univ Hosp, Dept Med, Jin Shan Branch Minist Hlth & Welf,Taoyuan Gen Hosp, Dept Internal Med Natl Yang Ming Univ, Sch Publ Hlth Natl Cheng Kung Univ Hosp, Dept Internal Med Natl Cheng Kung Univ, Dept Med, Med Coll Far Eastern Mem Hosp, Dept Internal Med Natl Yang Ming Univ, Sch Med Changhua Christian Hosp, Dept Internal Med Chung Shan Med Univ, Sch Med Chung Shan Med Univ Hosp, Dept Internal Med Chi Mei Med Ctr, Dept Internal Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Triserv Gen Hosp, Dept Internal Med Natl Def Med Ctr Ditmanson Med Fdn,Chia Yi Christian Hosp, Dept Internal Med Taichung Vet Gen Hosp, Dept Internal Med Natl Taiwan Univ Hosp, Dept Internal Med, Hsin Chu Branch Natl Taiwan Univ Hosp, Dept Internal Med Natl Taiwan Univ, Coll Med Natl Taiwan Univ, Coll Med, Dept Parasitol China Med Univ Hosp, Dept Med Res China Med Univ
Keywords:	Transmitted Drug-Resistance Hepatitis-B-Virus Treatment Response Cell Count Infection Care Transmission Metaanalysis Prevalence Africa
Date:	2017-06-30
Issue Date:	2018-11-30 15:55:45 (UTC+8)
Publisher:	Public Library Science
Abstract:	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 <200 cells/mm(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/mm 3 in 2012 to 298 cells/mm 3 in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (P for trend <0.001). Late cART initiation mainly resulted from late presentation for HIV care and was associated with older age (per 1-year increase, adjusted odds ratio [AOR], 1.05; 95% CI, 1.04-1.06), HBsAg seropositivity (AOR, 1.31; 95% CI, 1.04-1.64), HIV care in central and southern Taiwan, initiating cART in earlier year, non-intravenous drug users (AOR, 1.96; 95% CI, 1.33-2.86), and negative hepatitis C serostatus (AOR, 1.47; 95% CI, 1.04-2.08). Compared with non-late initiators, late initiators had a higher rate of all-cause mortality (1.7% vs. 0.3%) and regimen modification due to virological failure (7.1% vs. 2.6%). The predicting factors of all-cause mortality were late cART initiation (adjusted hazard ratio [AHR], 5.40; 95% CI, 2.14-13.65) and older age (AHR, 1.06; 95% CI, 1.03-1.10). 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.
Relation:	Plos One, v.12, n.6, e0179870
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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