Declines in highly active antiretroviral therapy initiation at CD4 cell counts ≤ 200 cells/μL and the contribution of diagnosis of HIV at CD4 cell counts ≤ 200 cells/μL in British Columbia, Canada

Abstract

Objectives The aim of the study was to examine trends in initiating highly active antiretroviral therapy (HAART) with a CD4 count ≤ 200 cells/µL and the contribution of having a CD4 count ≤ 200 cells/µL at the time of diagnosis to these trends, in British Columbia (BC), Canada. Methods We included in the analysis treatment-naïve BC residents aged ≥ 19 years who initiated HAART from 2003 to 2012. Participants were classified as follows: Group 1: diagnosed and initiated HAART with a CD4 count > 200 cells/µL; Group 2: diagnosed with a CD4 count > 200 cells/µL and initiated HAART with a CD4 count ≤ 200 cells/µL; and Group 3: diagnosed and initiated HAART with a CD4 count ≤ 200 cells/µL. We measured trends in initiating HAART with a CD4 count ≤ 200 cells/µL and used logistic regression models to measure factors associated with initiating HAART with a CD4 count ≤ 200 cells/µL, stratified by having a CD4 count ≤ 200 cells/µL or > 200 cells/µL at the time of diagnosis. Results Between 2003 and 2012, 3506 BC residents initiated HAART. Of these, 44% (1558 of 3506) initiated HAART with a CD4 count ≤ 200 cells/µL. This proportion declined from 69% (198 of 287) in 2003 to 21% (81 of 330) in 2012 (P < 0.001). The proportion of those in Group 3 increased from 49% (97 of 198) in 2003 to 69% (56 of 81) in 2012 (P < 0.001). Overall, 56% (1948), 22% (776) and 22% (782) made up Groups 1, 2, and 3, respectively. In adjusted analyses, seeing a specialist was significantly associated with being in Group 3. Using injection drugs and seeing a specialist were associated with being in Group 2. Conclusions In recent years, among individuals who ever initiated HAART in BC, being diagnosed with low CD4 cell counts has become a greater contributor to initiating HAART with low CD4 cell counts.

Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study

“…Consistent with prior results from BC, older age was associated with late and delayed ART initiation (Lourenco et al, 2015;Palmer et al, 2014). Notably, other research has found younger age to be associated with attrition in HIV care over time (Lourenco et al, 2014), suggesting a missed opportunity to retain younger people.…”

“…Based on prior studies in BC, variables we expected to predict late initiation included the history of IDU, HCV seropositivity, and lower income (Joseph et al, 2016;Lourenco et al, 2015;Palmer et al, 2014). Our findings may reflect changing characteristics of new initiators in BC, or may be due to limited sample size and a high percentage of participants with a history of IDU and HCV seropositivity, which left little room to examine variability.…”

“…Key explanatory variables, established by previous research to impact timing of initiation (Cescon et al, 2015;Joseph et al, 2016;Lourenco et al, 2015;Palmer et al, 2014), included: sex at birth, age, ethnicity, HCV seropositivity, history of IDU, history of homelessness, and income. Additional variables included in this analysis were: physician advice regarding ART initiation, medical reasons for initiating ART, concerns about ART, and participant scores on the Antiretroviral Medication Attitude Scale (AMAS) (Viswanathan, Aanderson, & Thomas, 2005), the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) (Johnson et al, 2007), and the Continuity of Care Scale (Uijen et al, 2012).…”

Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999–2013)

“…Other priority populations identified in Ontario's HIV/ AIDS strategy include people who use drugs and at-risk women [43], and we observed interesting findings for both. Participants who had ever injected drugs in our analysis were less likely to be diagnosed or present to care late, a finding also observed in other jurisdictions [28,44,45]. People who inject drugs may be a more accessible group to whom testing can be offered via harm reduction services (e.g.…”

<p>Assessment of Pattern of CD4+ T-Cell Recovery Among Human Immunodeficiency Virus Patients After Initiation of Highly Active Antiretroviral Therapy at Arsi Negelle Health Center, Ethiopia: A Retrospective Cross-Sectional Study</p>

“…2 The inhibition of virus replication permits restoration of the immune system thereby preventing or delaying the clinical progression of HIV disease. 3,4 HAART has resulted in substantial reductions in HIVassociated morbidity and mortality. 4,5 changing an HIV diagnosis into a manageable chronic infection in Ethiopia even though there is a regional variation in the extent of its benefit.…”