Infectious Disease

Individuals with HIV obtain earlier remedy, however the variations nonetheless persist

March 08, 2021

2 min read

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Li J et al. Abstract 104. Presented at: Conference on Retroviruses and Opportunistic Infections; 6-10 March 2021 (virtual meeting).

Disclosure:
Li does not report any relevant financial information.

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Timely ART has become more common in the US since the HHS treatment guidelines for HIV were published in 2012, including among groups who have historically been exposed to racial, ethnic, and some geographic differences, researchers reported.

According to researchers at the Virtual Conference on Retroviruses and Opportunistic Infections, people with HIV who are diagnosed with drug addiction and / or abuse are still faced with differences, suggesting that additional support services are needed.

“We needed to study trends and socio-demographic and clinical differences in receiving ART prescriptions on time to determine which subpopulations require additional support services.” Jun Li, MD, PhD, MPH, Healio said, an epidemiologist in the CDC’s HIV / AIDS Prevention Division. “These data will be important in identifying and filling gaps in HIV treatment for better health outcomes.”

Li and colleagues studied HIV treatment-naïve adults who had newly presented to 13 clinical cohorts of the North American AIDS Cohort Collaboration for Research and Design (NA-ACCORD) in the United States between 2012 and 2018 and who recorded a CD4 when they presented.

Jun Li

According to the study, the researchers calculated the cumulative incidence of timely ART within 30 days of entering care and used models to assess timely ART trends by calendar year, adjusted for age, gender, risk group, race / ethnicity, geographic Region, AIDS diagnosis, history of alcohol or drug addiction / abuse, mental health diagnosis, and CD4 and viral load at presentation.

Of the 11,853 treatment-naïve eligible participants who enrolled in the study, 48% were men who had sex with men, 14% were women, 45% were blacks, 15% were Hispanic / Latino, and 32% were between 18 and 29 years old and 7% were 60 years or older.

The study showed that the cumulative incidence of timely ART increased from 42% in 2012 to 82% in 2018. However, a multivariate model for 2012 to 2018 showed lower rates of timely ART among more black than white participants (adjusted HR = 0.89; 95)% CI, 0.83-0.94), people living in the South than living in the West (aHR = 0.78; 95% CI, 0.69-0.88) and participants with a history of drug addiction / abuse diagnosis (aHR = 0.81; CI, 0.74-0.9)) .

The researchers also found that from 2016 to 2018, black participants (aHR = 0.92; 95% CI, 0.83-1.02) and people in the South (aHR = 0.97; 95% CI, 0.75 -1.26) no longer had significantly lower rates of timely ART, but participants in the northeast had higher rates (aHR = 1.37; 95% CI, 0.99-1.9) than people in the west. In addition, drug addiction and history of abuse remained associated with delayed ART (aHR = 0.72; 95% CI, 0.61-0.85).

“Substantial improvements in initiating ART in a timely manner after the 2012 HIV Treatment Guidelines were published indicate widespread acceptance and implementation of these guidelines by healthcare providers,” said Li. “Ending the HIV epidemic in the US can only be achieved, however by removing the barriers that prevent equitable access to HIV treatment and care. This includes addressing the root causes and social determinants that have contributed to differences between particular populations for far too long. ”

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Gitanjali Pai, MD, AAHIVS, FIDSA)

Gitanjali Pai, MD

While it is extremely encouraging to see the increase in the cumulative incidence of timely ART, this study provides a reality check where we need to further focus, and indeed our efforts to provide timely ART for the vulnerable and frequently withdrawn group Increase drug addiction and abuse. This is an important step towards public health, and we owe it not only to the health of the individual but also to society to strive for a contemporary ART that conforms to the maxim “undetectable = non-transferable”. The stakes are high and we have to be willing to go the extra mile to ensure a timely ART in this population.

Gitanjali Pai, MD

Member of the editorial team for infectious diseases

Adjunct Clinical Assistant Professor of Rural Health Internal Medicine / Infectious Disease

Oklahoma State University

Infectious Disease Doctor

Memorial Hospital and Medical Clinic, Stilwell, Oklahoma

Disclosure: Pai does not report any relevant financial information.

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Conference on Retroviruses and Opportunistic Infections (CROI)

Conference on Retroviruses and Opportunistic Infections (CROI)

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