Impact of delayed initiation of antiretroviral therapy in patients with HIV infection

Abstract

Objective — to analyze the effect of the duration of the period from the moment of infection to the appointment of antiretroviral treatment in patients with HIV infection as a predictor of an unfavorable course of the disease. 
 Materials and methods. A retrospective and prospective study was conducted among a cohort of people living with HIV (PLHIV), which included 450 patients. The observation lasted 60 months. 63 patients died from HIV-related causes, 14 from non-HIV and immune reconstitution inflammatory syndrome (IRIS) causes, 69 patients interrupted antiretroviral therapy (ART) for various reasons during the follow-up period. By the end of the follow-up period, 304 patients remained on ART. Statistical processing of the results was carried out using the STATISTICA v. 6.1 application package. 
 Results and discussion. Based on the results of a correlation analysis of clinical and laboratory parameters of a cohort of HIV-infected patients, 10 main risk factors were selected, including the delayed initiation of antiretroviral treatment. After 5 years of follow-up, the main reason for the loss of patients from the cohort was interruption of therapy — 69 (15.3 %) people, 63 (14.0 %) died from HIV-related causes, and 14 (3.1 %) died from causes unrelated to HIV and IRIS. Causes associated with the undesirable clinical outcomes of ART were noted in 30.4 % of people — allergic reactions, taking therapy together with anti-TB therapy, in turn, led to the development of IRIS and an increase in adverse events. 
 Conclusions. The analysis shows that despite the high intensity of the prescribed primary treatment regimens for patients with HIV infection, such a factor as the delayed initiation of ART has a significant negative impact on the further course of HIV infection and the development of adverse events, worsening the prognosis of the disease.