Care Of HIV-infected Patients Research Articles

Barriers to Hepatitis C Virus (HCV) Treatment Initiation in Patients With Human Immunodeficiency Virus/HCV Coinfection: Lessons From the Interferon Era.

Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population. Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation. Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26-3.95), recent active drug use (OR, 0.36; 95% CI, 0.19-0.69), and non-black race (OR, 2.01; 95% CI, 1.26-3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%-49% missed visits [OR, 0.49; 95% CI, 0.27-0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12-0.48]). Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.

Incidence and Risk Factors for Venous Thrombosis in Human Immunodeficiency Virus (HIV) Infection, Data from the Dutch Athena Cohort Study

Incidence and Risk Factors for Venous Thrombosis in Human Immunodeficiency Virus (HIV) Infection, Data from the Dutch Athena Cohort Study

Increased homocysteine plasma level is associated with shortened prothrombin time in HIV-infected patients

Objective: To find factors associated with increased homocysteine plasma level in HIV-infected patients.Methods: Cross-sectional study, carried out as a supplementary task to the standard care of HIV-infected patients. The possible association of increased homocysteine plasma level with blood analyses results was assessed with a multiple linear regression analysis, using the automatic linear modeling available in SPSS version 22.Results: A total of 145 patients were included. Creatinine was higher than normal in 7 patients (5%), prothrombin time was shortened in 36 patients (25%), and a monoclonal gammopathy was detected in 2 patients (1%). In the regression analysis, an association was found between high homocysteine plasma level and the following variables: low prothrombin time (β coefficient −0.286, confidence interval −1.1854 to −0.754, p < 0.001), high creatinine (coefficient 9.926, confidence interval 6.351–15.246, p < 0.001), low folic acid (coefficient −0.331, confidence interval −0–483 to −0.187, p < 0.001), and low vitamin B12 (coefficient −0.007, confidence interval −0.01 to −0.001, p = 0.005).Conclusion: An association was found between increased homocysteine plasma level and shortened prothrombin time.

End-of-life care for HIV-infected patients with malignancies: A questionnaire-based survey

Background: The number of HIV-infected patients who require palliative or end-of-life care is increasing, and the status of end-of-life care for HIV patients with malignancies is unclear. Aim: This study aimed to evaluate the end-of-life care provided to HIV patients with malignancies in Japan. Design: National cross-sectional questionnaire-based survey. Setting/participants: Questionnaires were delivered to the medical staff of 378 regional core hospitals/core hospitals for AIDS and 285 palliative care units in Japan. Data were collected between August and October 2013. Results: Overall, 226 regional core hospitals/core hospitals for AIDS (59.8%) responded. A total of 55 institutions (24.3%) provided end-of-life care to HIV patients with malignancies. Regarding the place of death of the patients, 69.1% died at the institution whereas 18.2% were transferred to palliative care units. The requests of 16 (29.1%) institutions to transfer patients to palliative care units were rejected. Of the 378 palliative care units, 179 (62.8%) responded. While 13 palliative care units (4.6%) provided care to hospitalized HIV patients with malignancies, 20 (11.2%) refused to accept these patients for treatment because of a lack of experience in treating these patients and a lack of knowledge regarding HIV infection. Conclusion: Our findings suggest that in Japan, HIV patients with malignancies have difficulties obtaining hospitalization at a palliative care unit, which is likely due to a lack of experience among the professionals in treating such patients as well as a lack of knowledge about HIV.

Acceptability of Couples' Voluntary HIV Testing Among HIV-infected Patients in Care and Their HIV-negative Partners in the United States.

Introduction:Couples’ voluntary HIV counseling and testing (CHTC) is an HIV risk reduction strategy not widely available in the US. Methods:We assessed willingness to participate in CHTC among US HIV-infected clinic patients via tablet-based survey and among HIV-negative persons with HIV-infected partners in care via mixed-method phone interviews.Results:Most of the N=64 HIV-infected partners surveyed were men (89%), on antiretroviral treatment (ART) (92%), and many self-identified homosexual (62%). We observed high levels of willingness to participate in CHTC (64%) among HIV-infected partners. Reasons for not wanting to participate included perceived lack of need (26%), desire to self-disclose their status (26%), and fear of being asked sensitive questions with their partner present (17%). HIV-infected partners were interested in discussing ART (48%), other sexually transmitted infections (STIs) (44%), and relationship agreements like monogamy (31%) during CHTC sessions. All N=15 HIV-negative partners interviewed were men, most identified as homosexual (73%), and about half (54%) reported consistent condom use with HIV-infected partners. We observed high levels of willingness to participate in CHTC (87%) among HIV-negative partners, who were also interested in discussing ART (47%), other STIs (47%), mental health services (40%), and relationship agreements (33%). Most negative partners (93%) indicated that they believed their HIV-infected partner was virally suppressed, but in the event that they were not, many (73%) were willing to take pre-exposure prophylaxis (PrEP).Conclusion:These results indicate that CHTC for serodiscordant couples is acceptable and should emphasize aspects most pertinent to these couples, such as discussion of ART/PrEP, STIs, and relationship agreements.

What is the role of CD4 count in a large public health antiretroviral programme?

No abstract available.

Timing Matters - Influenza Vaccination to HIV-Infected Patients.

Patients with HIV infection vaccinated early in the flu season are more likely to contract influenza or influenza-like illness (ILI) compared with those receiving late vaccination. It is known that antibody titres wane over time, particularly among individuals with HIV infection. It is unclear if the timing of influenza vaccination within the flu season affects the probability of an influenza infection later during the flu season. The aim of this study is to evaluate if there is a relationship between the timing of influenza vaccination and incidence of influenza or ILI in patients with HIV infection. A retrospective cohort study of HIV-infected patients in care at the Department of Veterans Affairs San Diego Healthcare System was conducted from 1 September 2005 to 31 May 2013. Among these patients, we evaluated whether there was a relationship between the timing of influenza vaccination and the incidence of laboratory-confirmed influenza, influenza diagnosed by a physician, or ILI. Patients who received influenza vaccine early in the season were more likely to contract influenza or ILI than patients who were vaccinated late (P < 0.01). Vaccinated patients who developed influenza or ILI were more likely to do so later in the season (P < 0.01). HIV-infected patients vaccinated early in the flu season were more likely to contract influenza or ILI than those vaccinated later in the season.

Long term adverse drug reaction to Efavirenz in a HIV infected adolescent

Efavirenz is one of the medications used in combined antiretroviral therapy (ART) for the management of HIV infection in adolescents. Various central nervous system adverse reactions have been reported in patients commencing antiretroviral therapy with a regimen containing Efavirenz. These reactions tend to be acute, commonly occurring in the first six months of therapy. Adverse reactions following long term use of Efavirenz for ART is rare among adults and rarer still among children and adolescents. There is only one published case of serious adverse reaction to Efavirenz in an adolescent after long-term use. The case of a male HIV Positive Nigerian patient aged 13 years. He presented with five-day history of Difficulty sleeping, abnormal dreams, inability to concentrate, restlessness, irrational behavior and long-term memory loss. There was no previous history of psychiatric illness and no suggestive social or family history. Patient was on Efavirenz containing regimen about 6.5 years till presentation with adverse reaction mainly affecting behavior, thought processes and memory. After discontinuing Efavirenz and replacing with Nevirapine in his combined ART regimen, all neuropsychiatric manifestations ceased .He regained his memory, no longer had bad dreams or demonstrated any irrational behavior or attitude. Physicians who are involved in the care of HIV infected patients need to be aware of the possibility of adverse Drug reactions occurring in patients who have been on antiretroviral drugs for years. This possibility should not be excluded from possible differential diagnosis. KEY WORDS: Adolescent; Efavirenz; HIV Infection; Reactions; Adverse drug; Psychomotor Agitation; Long term

Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands.

Successful treatment of people infected with HIV requires that patients are retained in HIV care, use combination antiretroviral therapy (cART) and ultimately reach and sustain viral suppression. Our aim was to identify health facility characteristics associated with these steps in the cascade of HIV care. Retrospective cohort study. We included data from all adult HIV-1-infected patients who entered care in the Netherlands between 2007 and 2013 (N = 7120). Multivariate logistic regression was used to examine the associations between health facility characteristics and the outcomes 'currently in care', 'initiated cART', and 'viral suppression'. The proportion of patients 'currently in care' was high in all 26 treatment centres. cART initiation was positively associated with the accreditation of the health facility [OR (odds ratio): 1.62; 95% CI (confidence interval): 1.18-2.23] and the performance of an internal audit in the preceding 3 years (OR: 1.36; 95% CI: 1.02-1.81). The odds of cART initiation were higher in middle-sized (OR: 2.00; 95% CI: 1.25-3.21) and large HIV treatment centres (OR: 1.80; 95% CI: 1.14-2.84) compared with small centres (<300 HIV-infected patients). Viral suppression was negatively associated with the presence of a social worker in the HIV treatment team (OR: 0.62; 95% CI: 0.43-0.91). Our results confirm that appointing expert HIV treatment centres facilitates retention in care and that a minimum volume requirement may be desirable. Our findings suggest that quality assessment through accreditation and the measurement of performance benefits the delivery of HIV care.

Comprehensive care for elderly HIV infected patients

Comprehensive care for elderly HIV infected patients

Addressing the Unmet Need for ART among HIV+ Women and Newborns in Cameroon through Strengthening the Supply Chain of PMTCT Commodities

Background: The Government of Cameroon and its partners have made major investments in the last decade in prevention, treatment, and care of HIV-infected patients. However, unmet need for antiretroviral therapy (ART) among HIV-positive pregnant women remains high at 66%. Critical to satisfying this need is ensuring adequate availability of prevention of mother-to-child transmission (PMTCT) commodities for rollout of new Option B+ guidelines. The Cameroon supply system consists of a cost recovery system for essential medicines and other health commodities and a free-of-charge system for priority commodities including those for PMTCT and ART. This study examines options for improving the supply and availability of these commodities. Method: Supply chain (SC) operational data was collected in July 2014 from central (CENAME) and 4 regional warehouses (CAPRs); 10 district stores; and 30 service delivery points (SDPs), including ART and PMTCT sites. The study also included seven central private-sector logistics firms. In addition, SC cost data was obtained from CENAME and CAPRs financial statements audited in 2013. Data collected served for analysis of three options to improve effectiveness of delivering PMTCT commodities, based on the four variables detailed in Figure 2.4.1. Results: Asset utilization within the cost recovery system ranged between 73% and 89% while inventory turnover was at 1.5. Therefore, a reliable supply of medicines to SDPs is ensured. However, for PMTCT and ART commodities, distribution to the SDPs was unreliable (in 2013, 40% of prescriptions remained unfilled). Meanwhile, results of the options analysis indicated that the model of CAPRs delivering PMTCT commodities to SDPs was the most desirable. Although the distance traveled was higher, the need for network storage space was minimal. Moreover, its total cost and human resource requirements were more favorable. Conclusion: As a result of disseminating the findings, the Ministry of Health adopted Option 2. PMTCT free-of-charge commodities are also amenable to being managed within the existing effective cost recovery system.

Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants.

BackgroundThe Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors.MethodsData on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied.ResultsOf all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression.ConclusionsThe continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.

Nursing Students' Willingness to Care for Human Immunodeficiency Virus-Infected Patients in the Future.

Recent studies in various countries have shown controversy regarding students' willingness to care for human immunodeficiency virus (HIV)-infected patients as well as factors associated with students' decisions about this issue. This survey, based on the Theory of Planned Behavior, explored factors associated with Israeli nursing students' willingness to care for HIV-infected patients in the future. The results suggest that appropriate education and experience in caring for HIV-infected patients are critical for improving students' willingness to care for these patients.

Features of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso).

To study the features of metabolic syndrome (MS) and its associated factors during highly active antiretroviral therapy (HAART), in Ouagadougou. It was a cross-sectional study from March to November 2011 in Yalgado Ouédraogo hospital. A nonprobability sample of adults receiving antiretroviral drugs for at least 6 months was studied. Pregnancy, ascites, or abdominal mass were noninclusion criteria. Metabolic syndrome met the criteria of International Diabetes Federation 2005. The authors studied 300 patients. Metabolic syndrome was diagnosed in 54 (18%) patients: mean age 44.8 ± 7.4 years, sex ratio 0.17, and mean duration of HAART 71 ± 30.9 months. The current anomaly of MS was low high-density lipoprotein (HDL)-cholesterol in 37 patients (68.5%), and the common profile of MS was high waist circumference + low HDL-cholesterol + abnormal blood pressure (29.6%). Associated factors were protease inhibitor regimens (P = .000), female gender (P = .004), age > 42 years (P = .001), and lipodystrophy (P = .01). Cardiovascular risks should be regarded during the care of HIV-infected patients.

Pulmonary Complications of HIV

Pulmonary Complications of HIV summarizes current practices for diagnosing and treating common HIV-related pulmonary complications. It is a well-written, educational work that will interest anyone managing the care of HIV-infected persons. The content and amount of information packed into this easy-to-read textbook is impressive. Each chapter is well organized and well referenced, and important concepts and definitions are laid out clearly. Since HIV/AIDS was first described, clinicians have found that the lung is the site most frequently affected and that pulmonary complications are a major cause of illness and death for HIV-infected persons. However, over the years, the discovery and use of antiretroviral therapy has increased life expectancy for HIV-infected persons, and the spectrum of infectious and noninfectious pulmonary complications has changed. For example, the incidence of opportunistic pneumoniashas declined dramatically, whereas the incidence of bacterial pneumonia has not decreased proportionately. Furthermore, noninfectious complications, such as chronic obstructive pulmonary disease and lung cancer, are increasing. It is critical for anyone managing the care of HIV-infected persons to be aware of these lung complications and understand their diagnoses, possible treatments, and prevention. Pulmonary Complications of HIV does an excellent job discussing these aspects. The authors are well-respected researchers and clinicians from throughout the world who work in the fields of pulmonary medicine and HIV-related lung diseases. The literature on HIV-related pulmonary complications is still lacking in certain areas, which most likely led to some chapters (e.g., Bronchiectasis)to be shorter and less comprehensive than others. Of the book’s 19 chapters, the first 2 discuss the global epidemiology of HIV and current antiretroviral therapy guidelines, which will be useful for clinicians who might not regularly manage the care of HIV-infected patients. The third chapter discusses pulmonary immunity, a complicated topic but one the authors explain simply by emphasizing essential concepts. The next several chapters highlight various diseases and strategies for preventing them in the field, including vaccine guidelines. In addition, the authors cover a number of other key aspects to HIV care, such as pregnancy, pediatrics, and infectious and noninfectious complications, completing a thorough review of the literature. Although infectious disease specialists and others who care for HIV-infected patients might consider the first few chapters too simplistic, the latter chapters on pulmonary complications will be relevant and instructive. Pulmonologists will find that the first few chapters discuss aspects of HIV care to which they are not readily exposed and the latter chapters provide information on the epidemiology, clinical manifestations, diagnosis, and management of common complications seen in HIV-infected persons. Pulmonary Complications of HIV does an exceptional job summarizing the major pulmonary manifestations of HIV/AIDS and discussing the progress in overall HIV treatment. Because the book itself is fairly short (265 pages), it appears to be more of a simple paperback rather than a reference textbook. Regardless, it is worthy of a spot on your bookshelf. As a clinician, educator, and researcher in the field of HIV-related lung disease, I found the book to be informative, easy to read, and a quick and simple reference to have on hand. It would be valuable to any medical trainee or clinician who manages the care of HIV-infected patients.

Opportunistic Infections and Mortality: Still Room for Improvement

Among the accomplishments having the greatest impact during the first decade of the AIDS epidemic was the rapid development of effective tools and strategies to diagnose, treat, and prevent opportunistic infections. Prior to 1981, clinicians had little experience with managing infections such as pneumocystis pneumonia, Toxoplasma cerebritis, cytomegalovirus (CMV) retinitis, disseminated Mycobacterium avium complex infection, and chronic diarrhea due to cryptosporidia or microsporidia. Highly effective drugs to treat CMV and M. avium complex infection had not been developed for clinical practice, and many physicians used intravenous pentamidine, a relatively toxic drug, to treat pneumocystis pneumonia. Aided by randomized prospective clinical trials and the development of national guidelines to rapidly disseminate new information [1], clinicians quickly learned how to recognize and treat these syndromes and diseases. In the eras when no antiretroviral therapy (ART) was available or when ART was limited to single or dual nucleoside agents, median survival times after the diagnosis of the first AIDS-associated opportunistic infection were very limited, ranging from 2 to 22 months, depending on the infection [2]. Human immunodeficiency virus (HIV) testing was not widely available, and most patients presented to healthcare providers with an opportunistic infection. Accordingly, most patients had profoundly depressed CD4 + T-cell counts at the time of presentation. There were limited programs to support retention in care for HIV-infected patients and no effective treatments for restoring immunologic function. In the late 1990s, with the development and availability of more-effective ART, immunity could be more effectively and durably restored, and health outcomes improved dramatically. To supplement the Ryan White Act of 1990 [3],more federal and local programs were developed to support retention in care. The management of opportunistic infections was improved by developing new molecular diagnostic tests, by developing new drugs, and by completing well-designed prospective studies. Medical support improved, especially in critical care departments where ventilator management, treatment for septic shock, and management of intracranial pressure, for in

Estimating the cost of increasing retention in care for HIV-infected patients: results of the CDC/HRSA retention in care trial.

Retaining HIV patients in medical care promotes access to antiretroviral therapy, viral load suppression, and reduced HIV transmission to partners. We estimate the programmatic costs of a US multisite randomized controlled trial of an intervention to retain HIV patients in care. Six academically affiliated HIV clinics randomized patients to intervention (enhanced personal contact with patients across time coupled with basic HIV education) and control [standard of care (SOC)] arms. Retention in care was defined as 4-month visit constancy, that is, at least 1 primary care visit in each 4-month interval over a 12-month period. We used microcosting methods to collect unit costs and measure the quantity of resources used to implement the intervention in each clinic. All fixed and variable labor and nonlabor costs of the intervention were included. Visit constancy was achieved by 45.7% (280/613) of patients in the SOC arm and by 55.8% (343/615) of patients in the intervention arm, representing an increase of 63 patients (relative improvement 22.1%; 95% confidence interval: 9% to 36%; P < 0.01). The total annual cost of the intervention at the 6 clinics was $241,565, the average cost per patient was $393, and the estimated cost per additional patient retained in care beyond SOC was $3834. Our analyses showed that a retention in care intervention consisting of enhanced personal contact coupled with basic HIV education may be delivered at fairly low cost. These results provide useful information for guiding decisions about planning or scaling-up retention in care interventions for HIV-infected patients.

Applying Margaret Newman’s Theory of Health as Expanding Consciousness to Psychosocial Nursing Care of HIV Infected Patients in Kenya

Margaret Newman’s Theory of Health as Expanding Consciousness is considered a grand nursing theory, she described a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world. Nurses in Kenya have mostly used the psychosocial-medical model to nurse HIV infected patients which fails to answer many of the nursing concerns and reduces their autonomy in carrying out nursing care. Newman’s theory proposed that: Health is not lack of illness, or a process to become healthy from being ill, but it instead the expansion of consciousness as a result of choices made within the context of patterns of behavior. Methodology: This mini review was an evolving emergent design. Slightly adapted ‘Advanced Theory in Nursing’ coursework materials were used. The greatest resource were referrals to links and hints as offered by those who got interested in the study. A best case scenario is appended. Conclusion: Newman’s Theory of Health as Expanding Consciousness is therefore a generic tool applicable to guide psychosocial nursing care of clients infected with HIV. It would be a great resource with a potential to evidence based nursing care. It would provide a basis for several case studies. Nurses find more fulfilment in their work by utilizing a nursing theory.

Factors associated with the continuum of care of HIV-infected patients in Belgium.

IntroductionWe studied factors associated with the continuum of HIV care in Belgium.MethodsData of the national registration of new HIV diagnosis and of the national cohort of HIV-infected patients in care were combined to obtain estimates of and factors related with proportions of HIV-infected patients in each step of the continuum of care from diagnosis to suppressed viral load (VL). Factors associated with ignorance of HIV seropositivity were analyzed among patients co-infected with HIV and STI in the Belgian STI sentinel surveillance network. Associated factors were identified by multivariate logistic regression.ResultsAmong 4038 individuals diagnosed with HIV between 2007 and 2010, 90.3% were linked to care. Of 11684 patients in care in 2010, 90.8% were retained in care up to the following year, 88.3% of those were on ART, of whom 95.3% had suppressed VL (<500 cp/ml) (Figure 1). In multivariate analyses, factors associated with ignoring HIV+ status were being younger (p<0.001), being heterosexual compared to MSM, and of a region of origin other than Belgium, Sub-Saharan Africa and Europe. Non-Belgian regions of origin were associated with lower entry and retention in care (p<0.001 for both). Preoperative HIV testing was associated with lower entry in care (p=0.003). MSM had a higher retention in care (p<0.001), whilst IDU had lower retention (p=0.004). Low CD4 at first clinical contact and clinical reasons for HIV testing were independently associated with being on ART (p<0.001 for both); whilst prenatal HIV diagnosis was associated with lower proportion on ART (p=0.016) and lower proportion with suppressed VL among those on ART (p=0.005). Older age was associated with both being on ART and having suppressed VL among those on ART (p=0.007 and p<0.001 respectively), independently of time since HIV diagnosis (Table 1). ConclusionsRegions of origin and risk groups (MSM/heterosexual/IDU) are the main factors associated with ignorance of HIV seropositivity, entry and retention in care, but once the HIV patient is retained in care, no effect of these factors on the proportions on ART and with suppressed VL are observed. The association of prenatal HIV diagnosis and proportions on ART and with suppressed VL could be biased by transitory CD4 disturbances during pregnancy and ART discontinuation after pregnancy. The higher probabilities of older patients to be on ART and have suppressed VL once retained in care could be influenced by factors not studied here like comorbidities, adherence or duration on ART.

The cascade of care in the Eastern European country of Georgia.

Individual and public health benefits of antiretroviral therapy (ART) rely on successful engagement of HIV-infected patients in care. We aimed to evaluate the HIV care continuum in the Eastern European country of Georgia. The analysis included all adult (age ≥ 18 years) HIV-infected patients diagnosed in Georgia from January 1989 until June 2012. Data were extracted from the national HIV/AIDS database as of 1 October 2012. The following stages of the HIV care continuum were quantified: HIV infected, HIV diagnosed, linked to care, retained in care, eligible for ART and virologically suppressed. Of 3295 cumulative cases of adult HIV infection reported in Georgia, 2545 HIV-infected patients were known to be alive as of 1 October 2012, which is 52% of the estimated 4900 persons living with HIV in the country. Of the 2545 persons diagnosed with HIV infection, 2135 (84%) were linked to care and 1847 (73%) were retained in care. Of 1446 patients eligible for ART, 1273 (88%) were on treatment and 985 (77%) of them had a viral load <400 HIV-1 RNA copies/mL. Overall, 39% of those diagnosed and 20% of those infected had a suppressed viral load. The findings of our analysis demonstrate that the majority of patients diagnosed with HIV infection are retained in care. Loss of patients occurs at each step of the HIV care continuum, but the major gap is at the stage of HIV diagnosis. Reducing the number of persons living with undiagnosed HIV infection and simultaneously enhancing engagement in continuous care will be critical to achieve maximum individual and public health benefits of ART.