AIDS. 2021 Nov 11. doi: 10.1097/QAD.0000000000003131. Online ahead of print.
ABSTRACT
OBJECTIVE: To propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages.
DESIGN: The established 90-90-90 target follows a cross-sectional 4-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation and viral suppression (VS) durability.
METHODS: Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people living with HIV (PLHIV) by estimated time from infection to diagnosis; of those who ever initiated ΑRT or achieved VS by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and VS, treating loss-to-follow-up (LTFU) as competing event. VS was defined as viral load (VL)<500 copies/ml. VS durability was assessed by the CIF of VL rebound.
FINDINGS: 89.1% of PLHIV in 2018 were diagnosed (range of diagnoses: 1980-2018). Median time to diagnosis was 3.5 years (IQR:1.1-7.0). Among diagnosed 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9% and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved VS, of whom 87.4% were currently virally suppressed. The CIF of VL rebound was 24.2% at 5 years since first VS but substantially reduced in more recent years.
INTERPRETATION: The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC.
PMID:34772850 | DOI:10.1097/QAD.0000000000003131
