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Introduction <p>Data on the impact of World&#xa0;Health&#xa0;Organization (WHO)’s guideline changes and COVID-19 on ART initiation in the Asia–Pacific remain scarce. This study described temporal trends from HIV diagnosis to ART initiation from 2013 to 2023 and its associated factors.</p> Methods <p>Adults (≥ 18&#xa0;years) diagnosed with HIV after 2013 in a regional observational cohort were included. Fine and Gray competing risk regression examined predictors of ART initiation (≥ 3 antiretroviral medications), accounting for those lost to follow-up or deceased before treatment considered as competing risks.</p> Results <p>Among 14,968 participants, most were male (70.1%), with a median age of 36&#xa0;years (interquartile range [IQR]: 28–44). At HIV diagnosis, median CD4 count was 208 cells/µL (IQR: 69–395), and median viral load was 86,296 copies/mL (IQR: 13,186–392,000). Over 85% of participants had initiated ART during the study period. Median time from HIV diagnosis to ART initiation differed across years of HIV diagnosis: 51&#xa0;days (2013–2015), 28&#xa0;days (2016–2019), and 26&#xa0;days (≥&#xa0;2020). Factors associated with shorter time to ART initiation were higher country income-level (upper-middle: sub-distribution hazard ratio [SHR] = 1.34, 95% CI: 1.28, 1.40; high: SHR = 1.35, 95% CI: 1.28, 1.43; vs. lower-middle); HIV transmission via male-to-male contact (SHR = 1.06, 95% CI: 1.02, 1.11) or injection drug use (SHR = 1.23, 95% CI: 1.09, 1.38; vs. heterosexual contact); and later years of HIV diagnosis (2016–2019: SHR = 1.33, 95% CI: 1.28, 1.38; ≥ 2020: SHR = 1.40, 95% CI: 1.33, 1.48; vs. 2013–2015). Those with higher CD4 counts had longer time to ART start (350–499 cells/µL: SHR = 0.76, 95% CI: 0.67, 0.86; &gt; 500 cells/µL: SHR = 0.55, 95% CI: 0.49, 0.61; vs. CD4 &lt; 200 cells/µL).</p> Conclusion <p>Time to ART initiation from HIV diagnosis decreased after 2016, aligning with evolving WHO guidelines, and did not appear to be impacted by COVID-19. Optimizing treatment initiation during the treat-all era is crucial, especially among those with higher CD4 counts.</p>

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Temporal trends from HIV diagnosis to ART initiation among adults living with HIV in the Asia–Pacific (2013–2023)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月4日

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  • Thinh Toan Vu,
  • Dhanushi Rupasinghe,
  • Vohith Khol,
  • Romanee Chaiwarith,
  • Junko Tanuma,
  • Nagalingeswaran Kumarasamy,
  • Suwimon Khusuwan,
  • IKetut Agus Somia,
  • Sanjay Pujari,
  • Man Po Lee,
  • Rohidas T. Borse,
  • Sasisopin Kiertiburanakul,
  • Evy Yunihastuti,
  • Iskandar Azwa,
  • Jun Yong Choi,
  • Hsin-Pai Chen,
  • Rossana Ditangco,
  • Anchalee Avihingsanon,
  • Yasmin Gani,
  • Jeremy Ross,
  • Awachana Jiamsakul

摘要

Introduction

Data on the impact of World Health Organization (WHO)’s guideline changes and COVID-19 on ART initiation in the Asia–Pacific remain scarce. This study described temporal trends from HIV diagnosis to ART initiation from 2013 to 2023 and its associated factors.

Methods

Adults (≥ 18 years) diagnosed with HIV after 2013 in a regional observational cohort were included. Fine and Gray competing risk regression examined predictors of ART initiation (≥ 3 antiretroviral medications), accounting for those lost to follow-up or deceased before treatment considered as competing risks.

Results

Among 14,968 participants, most were male (70.1%), with a median age of 36 years (interquartile range [IQR]: 28–44). At HIV diagnosis, median CD4 count was 208 cells/µL (IQR: 69–395), and median viral load was 86,296 copies/mL (IQR: 13,186–392,000). Over 85% of participants had initiated ART during the study period. Median time from HIV diagnosis to ART initiation differed across years of HIV diagnosis: 51 days (2013–2015), 28 days (2016–2019), and 26 days (≥ 2020). Factors associated with shorter time to ART initiation were higher country income-level (upper-middle: sub-distribution hazard ratio [SHR] = 1.34, 95% CI: 1.28, 1.40; high: SHR = 1.35, 95% CI: 1.28, 1.43; vs. lower-middle); HIV transmission via male-to-male contact (SHR = 1.06, 95% CI: 1.02, 1.11) or injection drug use (SHR = 1.23, 95% CI: 1.09, 1.38; vs. heterosexual contact); and later years of HIV diagnosis (2016–2019: SHR = 1.33, 95% CI: 1.28, 1.38; ≥ 2020: SHR = 1.40, 95% CI: 1.33, 1.48; vs. 2013–2015). Those with higher CD4 counts had longer time to ART start (350–499 cells/µL: SHR = 0.76, 95% CI: 0.67, 0.86; > 500 cells/µL: SHR = 0.55, 95% CI: 0.49, 0.61; vs. CD4 < 200 cells/µL).

Conclusion

Time to ART initiation from HIV diagnosis decreased after 2016, aligning with evolving WHO guidelines, and did not appear to be impacted by COVID-19. Optimizing treatment initiation during the treat-all era is crucial, especially among those with higher CD4 counts.