Timely ART Initiation Varies Among Persons Who Have HIV, Study Finds

Despite HHS’ recommendation since 2012 that everyone with HIV start antiretroviral therapy (ART) soon after diagnosis regardless of CD4 cell count, uptick disparities remain and are especially apparent among persons with drug abuse or dependence, according to an abstract presented at the 2021 virtual Conference on Retroviruses and Opportunistic Infections.

There was an overall improvement in linkage to care within 30 days of diagnosis (timely initiation of care, per the study’s definition) between 2012 and 2018, rising from 42% to 82%, but between-group differences persisted and some changes were seen during the study period.

For example, noted Jun Li, MD, PhD, an epidemiologist in the CDC's HIV/AIDS Prevention division and lead study author, “In 2012-2015, timely antiretroviral therapy was significantly less common in the Northeast compared with the West, but that had flipped in the 2016-2018 period where the Northeast was providing timely antiretroviral therapy better than the West.”

Lin and colleagues analyzed data from North American AIDS Cohort Collaboration on Research and Design to investigate care trends in treatment-naive undiagnosed patients, including those with viral loads above 500 copies/mL. Results for entry into care were stratified by age, race/ethnicity geographic region, sex, and other factors, overall and for 2 time periods (2012-2015 and 2016-2018). The study cohort was primarily younger adults (77% , < 50 years), of a racial/ethnic minority group (45%, Black; 15%, Hispanic/Latino), men who had sex with other men (48%) or female (14%), and living in the South (51%) or West (28%).

Among the 11,853 persons living with HIV included in the study, 56% initiated ART within the 30-day window and their median time for doing so was 9 days.

Lower timely ART initiation results were seen in the following groups overall:

• Blacks vs Whites (adjusted HR [aHR], 0.89; 95% CI, 0.83-0.94)
• People living in the South vs West (aHR, 0.78; 95% CI, 0.69-0.88)
• Persons with a diagnosis of drug use/abuse (aHR, 0.81; 95% CI, 0.74-0.90)

When looking at just the later study years (2016-2018), some gaps had closed slightly but were still apparent:

• Blacks vs Whites (aHR, 0.92; 95% CI, 0.83-1.02)
• People living in the South vs West (aHR, 0.97; 95% CI, 0.75-1.26)

Meanwhile, significant improvements were seen in the Northeast (aHR, 1.37; 95% CI, 0.99-1.90) but rates for persons with a history of drug use or abuse remained stagnant (aHR, 0.72; 95% CI, 0.61-0.85) in the second time period.

In addition, when comparing 2012-2015 with 2016-2018, more people without drug-related issues vs those with an abuse history received timely care in both periods, with the difference more significant by the latter period:

• 2012-2015: 50% vs ~40%
• 2016-2018: 75% vs < 60%

Five percent of the entire study cohort had a clinical AIDS diagnosis at entry; 8%, alcohol use/abuse history; 11%, drug use/abuse history; 24%, mental health diagnosis; and 30%, CD4 count lower than 500 cells/mm³.

The authors praised the improvements in ART initiation and the closing of some treatment gaps, but warned against resting on these laurels, especially in light of the ongoing pandemic for which data are not yet available on these outcomes. In addition, care during the pandemic has stagnated at suboptimal levels among people living with HIV and comorbid drug abuse/dependence issues.

“Although race/ethnic and some geographic disparities in timely ART lessened, people living with HIV with drug dependence/abuse diagnosis still had deficits, suggesting the need for additional support services for this population,” they concluded.

Reference

Li J, Humes E, Hanna DB, et al. Presented at: Conference on Retroviruses and Opportunistic Infections; March 6-10, 2021. Accessed March 8, 2021. https://ww2.aievolution.com/cro2101/index.cfm?do=abs.viewAbs&abs=1777