Socio‐economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015

Abstract

IntroductionGuidelines regarding antiretroviral therapy (ART) initiation in HIV infection have varied over time, with the 2015 World Health Organization recommendation suggesting ART initiation at the time of diagnosis regardless of CD4 T‐cell counts. Herein, we investigated the influence of socio‐demographic and clinical factors in addition to time trends on early ART initiation among participants of the Montreal Primary HIV Infection Study.MethodsThe Montreal Primary HIV Infection Study is a prospective cohort established in three community medical centres (CMCs) and two university medical centres (UMCs). Recently diagnosed HIV‐infected adults were categorized as receiving early (vs. delayed) ART if ART was initiated within 180 days of the baseline visit. Associations between early ART initiation and socio‐demographic, socio‐economic and behavioural information were examined. Independent associations of factors linked with early ART initiation were determined using multivariable binary logistic regression analysis.ResultsA total of 348 participants had a documented date of HIV acquisition of <180 days. The median interquartile range (IQR) age of participants was 35 (28; 42) years and the majority were male (96%), having paid employment (63%), men who have sex with men (MSM) (78%) and one to four sexual partners in the last three months (70%). Participants presented with a median IQR HIV plasma viral load of 4.6 (3.7; 5.3) log10 copies/ml, CD4 count of 510 (387; 660) cells/μl and were recruited in CMCs (52%) or UMCs (48%). Early ART initiation was observed in 47% of the participants and the trend followed a V‐shaped curve with peaks in 1996 to 1997 (89%) and 2013 to 2015 (88%) with a dip in 2007 to 2009 (22%). Multivariable analyses showed that having a paid employment adjusted odds ratio (aOR: 2.43; 95% CI: 1.19, 4.95), lower CD4 count (aOR per 50 cell increase: 0.93; 95% CI: 0.87, 0.99) and care at UMCs (aOR: 2.03; 95% CI: 1.06 to 3.90) were independently associated with early ART initiation.ConclusionsEarly ART initiation during primary HIV infection was associated with diminished biological prognostic factors and calendar time mirroring evolution of treatment guidelines. In addition, socio‐economic factors such as having a paid employment, contribute to early ART initiation in the context of universal access to care in Canada.

Circulating (1→3)-β-D-glucan Is Associated With Immune Activation During Human Immunodeficiency Virus Infection

“…In a cross-sectional analysis, a total of 146 adult PLWH were enrolled from the Montreal Primary HIV Infection Study, Chronic Viral Illness Service, at the McGill University Health Centre, and Canadian HIV and Aging Cohort Study [22]. PLWH were categorized into those with early HIV infection (EHI) (n = 53), defined as being within 6 months of the estimated date of infection using the criteria by the National Institutes of Health Acute HIV Infection and Early Diagnosis Research Program [22], and those with chronic HIV infection (CHI) who were either untreated (n = 22) or ART treated (n = 71) [23]. PLWH were compared with 42 HIV-uninfected controls (UCs) who were also enrolled from the Montreal Primary HIV Infection Study at the Chronic Viral Illness Service as well as the Canadian HIV and Aging Cohort Study.…”

“…All participants were fasting at the time of blood collection. Participants were excluded if they presented with P. jiroveci pneumonia (PJP), oral and/or esophageal candidiasis, Aspergillus infection, chronic colitis, or any other acute conditions [22]. To account for potential confounders, we recorded Figure 1.…”

Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV‐infected pregnant women in Malawi

“…Tuberculosis, syphilis and malaria are common among HIV‐infected people and have been shown to correlate with stillbirth . Low socio‐economic status is associated with increased risk of stillbirth and delayed ART initiation , possibly because women with low socio‐economic status are less likely to make use of ANC, even if it is free.…”

Shifting the HIV Paradigm from Care to Cure: Proceedings from the Caribbean Expert Summit in Barbados, August 2017

“…14 He reminded the Summit that the “Treat All” paradigm had an echo in the “Hit Hard, Hit Early” campaign of the late 1990s, which was undermined by the toxicity and visibly stigmatizing side effects (i.e., lipodystrophy) of the medication available at that time. 15 …”