Abstract

We assessed the prevalence and factors related to the time to antiretroviral (ART) initiation among persons who entered HIV care and subsequently started ART in Croatia from 2005 to 2014. Included were patients ≥ 18 years, the follow-up ended on Dec/31/2017. 628 patients were included into the study 91.9% were men; median age was 36.1 (Q1–Q3: 29.6–43.8) years. Rapid (within 7 days of diagnosis) ART initiation was observed in 21.8% patients, 49.8% initiated ART within 30 days, 21.7% and 28.5% had intermediate (31 days–1 year) and late initiation (> 1 year), respectively. Of 608 patients that achieved an undetectable viral load, 94% had a plasma HIV-1 RNA < 50 copies/ml at last measurement after a median follow-up of 5.2 years. On quantile regression analysis, calendar year of entry into care, and markers of more advanced HIV disease (higher viral load, lower CD4 cell count and clinical AIDS) were significantly associated with earlier ART initiation. Early ART was not related to a gap in care afterwards at all quantiles. In conclusion, a significant proportion of patients started ART early in Croatia in 2005–2014. Early ART initiation led to durable viral load suppression and was not associated with a subsequent gap in care.

Highlights

  • A total of 628 patients were included into the study with a total of 4333.0 years of follow-up, of which 3684.9 (85%) years of follow-up were after antiretroviral therapy (ART) initiation

  • There was a trend for earlier initiation of ART among older patients, those with more severe HIV-disease

  • Among 244 patients with a CD4 cell count ≥ 350/mm[3] at inclusion into care ART initiation within 30 days of HIV diagnosis was observed in 40 (16.4%), it was more frequent in the period 2012 to 2014 (30/101, 29.7%) compared to the period 2005 to 2011 (10/143, 7.0%)

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Summary

Objectives

The aim of our study was to examine the timeliness of ART initiation among persons who entered HIV care in Croatia from 2005 to 2014

Methods
Results
Conclusion
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