Infectious Disease

The time from getting into HIV therapy to prescribing ART has been diminished by greater than 90%

January 24, 2021

2 min read

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Disclosure:
Crowell says he is a contributor to the Henry M. Jackson Foundation for the Advancement of Military Medicine, receiving research grants from the US Department of Defense and the NIH. Crowell also reports that ART was donated by Gilead Sciences for this study. Lee reports on grants made by the NIH to John Hopkins while conducting the study. In the studies you will find all relevant financial information from all other authors.

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According to a study published in Clinical Infectious Diseases, the median time between a patient entering HIV treatment and receiving an ART prescription decreased by more than 90% between 2005 and 2018.

“Great strides have been made in getting patients entering HIV treatment into treatment as soon as possible in the ‘treatment for all’ era. This is reflected in significant reductions in ART prescribing times and an increase in ART prescribing CD4 counts from 2005 to 2018, ” Jennifer S. Lee, PhD, Healio said, a research fellow in the epidemiology department at the Johns Hopkins Bloomberg School of Public Health. “In contrast, the increase in CD4 counts upon entering care over the same period was relatively small.”

Crowell quote

Lee and colleagues examined patient data from the North American AIDS Cohort Collaboration for Research and Design (NA-ACCORD), a collaboration of 20 cohort studies of people living with HIV in the US and Canada. This included adults aged 18 and over who participated in NA-ACCORD between January 2005 and December 2018. They excluded patients who participated in studies before participating in NA-ACCORD, studies from Canada, and interval cohort studies.

Among 32,013 adults who entered HIV treatment in the United States, the median time to prescribing ART decreased from 69 to 6 days between 2005 and 2018, according to the study. In addition, the mean CD4 count at entry into the HIV supply increased from 300 to 362 cells / L, while the mean CD4 count at the time of ART prescription increased from 160 to 364 cells / L.

“Given the adverse consequences of late diagnosis and entry into care, our results underscore the need for advanced HIV screening in clinical and community settings and an efficient link with post-diagnosis care,” said Lee.

Another study published in Clinical Infectious Diseases found that new criteria for acute and early HIV infection (AEHI) can be used in diagnostic algorithms to begin ART initiation without an HIV-RNA result.

“These new criteria may facilitate diagnosis, staging, and immediate ART initiation during acute and early HIV infection in future research studies and clinical practice.” Trevor A. Crowell, MD, PhD, Healio said, deputy director of the epidemiology and threat analysis division of the US military’s HIV research program.

Crowell and colleagues evaluated new AEHI criteria in a prospective ART initiation study. They included 5,354 adults in 30 locations in Africa, Asia and America who met at least one of the six criteria. They then confirmed the HIV infection and the Fiebig stage with centralized tests.

A total of 195 patients were included between 2017 and 2019. Of the participants, 87.7% initiated ART on the day of registration, while the remaining 12.3% initiated ART on the day after registration. AEHI was confirmed in 96.4% of patients, with 2% having a chronic infection and 1.5% no HIV. The Geenius Assay and ARCHITECT HIV Combo correctly identified 81.2% of Fiebig Stage 2 through 4 AEHI cases and no false positive results were observed.

“There may be barriers to using these criteria in other settings, including resource constrained environments and routine clinical care centers,” said Crowell. “However, as the test modalities used for the study become more widespread, implementing these criteria should become easier.”

References:

Crowell TA et al. Clin Infect Dis. 2020; doi: 10.1093 / cid / ciaa1893.

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