Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

Pérez-Patrigeón, Santiago; Camiro-Zúñiga, Antonio; Jaramillo-Jante, M R; Belaunzarán-Zamudio, Pablo F.; Crabtree-Ramírez, Brenda; Soto-Ramírez, Luis Enrique; Calva, Juan J.; Hernández-León, Christian; Mosqueda, Juan L.; Navarro-Álvarez, Samuel; Sierra‐Madero, Juan

doi:10.1111/hiv.12713

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Therefore, interventions to improve access to cART should be implemented among PLWH with acute HIV diagnosis. The rapid cART initiation strategy may help overcome these barriers of delayed linkage [ 59 ]. This strategy was launched in 2018 in Taiwan [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019

et al. 2022

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Introduction Late initiation (LI) of combination antiretroviral therapy (cART)—defined as having a CD4 + count of < 200 cells/μL or an AIDS-defining disease at cART initiation—has detrimental outcomes but remains prevalent worldwide, with LI trends and etiologies following the implementation of various HIV policies remaining underinvestigated. We assessed key concerns, characterized the determinants of various statuses at cART initiation, and evaluated the effects of those statuses on all-cause mortality after cART initiation. Methods This multicenter retrospective cohort study enrolled 1198 patients with newly diagnosed HIV infection during 2009–2019 who were grouped by status at cART initiation: those without LI (non-LI group, 56.01%); those with LI but without late presentation (LP) of HIV (LP: a CD4 + count of < 200 cells/μL at HIV presentation or AIDS events ≤ 3 months of HIV diagnosis) [LILP(−) group, 4.51%]; and those with LI and with LP of HIV [LILP(+) group, 39.48%]. Joinpoint regression was used to identify changes in LI proportion. Results The median CD4 + count at cART initiation increased significantly between 2009 (98 cells/μL) and 2015 (325 cells/μL) and stabilized thereafter ( P for trend < 0.001). For LI, we identified one joinpoint in 2015: a substantial decrease from 77.14% in 2009 to 34.45% in 2015, followed by a nonsignificant increase to 39.1% in 2019. Overall, LILP(+) explained 89.8% of LI, without significant changes (92.59% in 2009 to 94.23% in 2019). In addition to HIV diagnosis during 2009–2012, multinomial logistic regression identified an age over 30 years and acute HIV infection as risk factors for LILP(+) and LILP(−), respectively. LILP(−) and LILP(+) were associated with a higher all-cause mortality risk. Conclusion Given the rise in LI from 2015 in the era of treat-all and rapid cART initiation, strategic interventions to increase earlier cART initiation must be intensified in Taiwan, especially among populations with delayed access to HIV testing services.

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Section: Discussionmentioning

confidence: 99%

Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019

et al. 2022

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Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam

Dijkstra

Rooijen

Hillebregt

et al. 2020

Clinical Infectious Diseases

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Background Men who have sex with men (MSM) with acute HIV infection (AHI) are a key source of new infections. To curb transmission we implemented in August 2015 a strategy for rapid diagnosis of AHI and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression. Methods We included 63,278 HIV testing visits in 2008-2017, during which 1,013 MSM were diagnosed at the Amsterdam STI clinic. Standard of care (SOC) included HIV diagnosis confirmation in <1 week and cART initiation in <1 month. The AHI strategy comprised same-visit HIV diagnosis confirmation and immediate cART initiation. AHI diagnoses were assessed before and after implementation of the AHI strategy. Time from diagnosis to viral suppression was assessed for three cART initiation periods: (1) 2008-2011: cART initiation if CD4<500 cells/mm3 (SOC); (2) January 2012-July 2015: cART initiation if CD4<500 cells/mm3, or if AHI or early HIV infection (SOC); (3a) August 2015-June 2017: universal cART initiation (SOC); and (3b) August 2015-June 2017: the AHI strategy. Results Before implementation of the AHI strategy, the proportion of AHI of HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time from diagnosis to viral suppression during period 1, 2, 3a, and 3b was 584 (IQR, 267-1065), 230 (IQR, 132-480), 95 (IQR, 63-136), and 55 (IQR, 31-72) days, respectively (p<0.001). Conclusions Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.

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Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

Cited by 2 publications

References 15 publications

Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019

Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019

Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam

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