SidaSubSaharaV1, Main, Exploration, bibRecord, 000082

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

Identifieur interne : 000082 ( Main/Exploration ); précédent : 000081; suivant : 000083

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

Auteurs : Kuan-Yin Lin [Taïwan] ; Chien-Yu Cheng [Taïwan] ; Chia-Wen Li [Taïwan] ; Chia-Jui Yang [Taïwan] ; Mao-Song Tsai [Taïwan] ; Chun-Eng Liu [Taïwan] ; Yuan-Ti Lee [Taïwan] ; Hung-Jen Tang [Taïwan] ; Ning-Chi Wang [Taïwan] ; Te-Yu Lin [Taïwan] ; Yi-Chien Lee [Taïwan] ; Shih-Ping Lin [Taïwan] ; Yu-Shan Huang [Taïwan] ; Jun-Yu Zhang [Taïwan] ; Wen-Chien Ko [Taïwan] ; Shu-Hsing Cheng [Taïwan] ; Chien-Ching Hung [Taïwan]

Source :

PLoS ONE [ 1932-6203 ] ; 2017.

RBID : PMC:5493332

Abstract

Objectives

The international and national HIV treatment guidelines in 2016 have focused on scaling up access to combination antiretroviral therapy (cART). We aimed to assess the trends and treatment outcomes of late cART initiation in Taiwan.

Methods

Between June 2012 and May 2016, we retrospectively included antiretroviral-naive HIV-positive adults who initiated cART. Late initiation was defined as when cART was initiated in patients with a CD4 count <200 cells/mm³ or having experienced AIDS-defining illnesses. The treatment outcomes were assessed up to 6 months after starting cART.

Results

We included 3655 HIV-positive patients, and the majority of the patients were male (95.4%) with a median age of 31 years and initiated non-nucleoside reverse-transcriptase inhibitor-containing regimens (87.0%). The median CD4 count at cART initiation increased from 207 cells/mm³ in 2012 to 298 cells/mm³ in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (P for trend <0.001). Late cART initiation mainly resulted from late presentation for HIV care and was associated with older age (per 1-year increase, adjusted odds ratio [AOR], 1.05; 95% CI, 1.04–1.06), HBsAg seropositivity (AOR, 1.31; 95% CI, 1.04–1.64), HIV care in central and southern Taiwan, initiating cART in earlier year, non-intravenous drug users (AOR, 1.96; 95% CI, 1.33–2.86), and negative hepatitis C serostatus (AOR, 1.47; 95% CI, 1.04–2.08). Compared with non-late initiators, late initiators had a higher rate of all-cause mortality (1.7% vs. 0.3%) and regimen modification due to virological failure (7.1% vs. 2.6%). The predicting factors of all-cause mortality were late cART initiation (adjusted hazard ratio [AHR], 5.40; 95% CI, 2.14–13.65) and older age (AHR, 1.06; 95% CI, 1.03–1.10).

Conclusions

While the proportion of late cART initiation decreased over time in Taiwan, late initiation remained in a substantial proportion of HIV-positive patients. The late initiators had higher risk for poor outcomes. The need for strategies to earlier detection of HIV infection and expediting cART initiation should be highlighted, especially among the older population.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493332

DOI: 10.1371/journal.pone.0179870
PubMed: 28665938
PubMed Central: 5493332

Affiliations:

Taïwan

Le document en format XML

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<author><name sortKey="Lee, Yuan Ti" sort="Lee, Yuan Ti" uniqKey="Lee Y" first="Yuan-Ti" last="Lee">Yuan-Ti Lee</name>
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<author><name sortKey="Tang, Hung Jen" sort="Tang, Hung Jen" uniqKey="Tang H" first="Hung-Jen" last="Tang">Hung-Jen Tang</name>
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<author><name sortKey="Wang, Ning Chi" sort="Wang, Ning Chi" uniqKey="Wang N" first="Ning-Chi" last="Wang">Ning-Chi Wang</name>
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<author><name sortKey="Lin, Te Yu" sort="Lin, Te Yu" uniqKey="Lin T" first="Te-Yu" last="Lin">Te-Yu Lin</name>
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<author><name sortKey="Lee, Yi Chien" sort="Lee, Yi Chien" uniqKey="Lee Y" first="Yi-Chien" last="Lee">Yi-Chien Lee</name>
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<author><name sortKey="Lin, Shih Ping" sort="Lin, Shih Ping" uniqKey="Lin S" first="Shih-Ping" last="Lin">Shih-Ping Lin</name>
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<author><name sortKey="Huang, Yu Shan" sort="Huang, Yu Shan" uniqKey="Huang Y" first="Yu-Shan" last="Huang">Yu-Shan Huang</name>
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<wicri:regionArea>Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu</wicri:regionArea>
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<author><name sortKey="Zhang, Jun Yu" sort="Zhang, Jun Yu" uniqKey="Zhang J" first="Jun-Yu" last="Zhang">Jun-Yu Zhang</name>
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<author><name sortKey="Ko, Wen Chien" sort="Ko, Wen Chien" uniqKey="Ko W" first="Wen-Chien" last="Ko">Wen-Chien Ko</name>
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<author><name sortKey="Cheng, Shu Hsing" sort="Cheng, Shu Hsing" uniqKey="Cheng S" first="Shu-Hsing" last="Cheng">Shu-Hsing Cheng</name>
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<author><name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
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<affiliation wicri:level="1"><nlm:aff id="aff020"><addr-line>Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan</addr-line>
</nlm:aff>
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<wicri:regionArea>Department of Parasitology, National Taiwan University College of Medicine, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
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<affiliation wicri:level="1"><nlm:aff id="aff021"><addr-line>Department of Medical Research, China Medical University Hospital, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Medical Research, China Medical University Hospital, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
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<affiliation wicri:level="1"><nlm:aff id="aff022"><addr-line>China Medical University, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>China Medical University, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up</title>
<author><name sortKey="Lin, Kuan Yin" sort="Lin, Kuan Yin" uniqKey="Lin K" first="Kuan-Yin" last="Lin">Kuan-Yin Lin</name>
<affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City</wicri:regionArea>
<wicri:noRegion>New Taipei City</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Cheng, Chien Yu" sort="Cheng, Chien Yu" uniqKey="Cheng C" first="Chien-Yu" last="Cheng">Chien-Yu Cheng</name>
<affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City</wicri:regionArea>
<wicri:noRegion>Taoyuan City</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>School of Public Health, National Yang-Ming University, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>School of Public Health, National Yang-Ming University, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Li, Chia Wen" sort="Li, Chia Wen" uniqKey="Li C" first="Chia-Wen" last="Li">Chia-Wen Li</name>
<affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, National Cheng Kung University Hospital, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Medicine, National Cheng Kung University Medical College, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Yang, Chia Jui" sort="Yang, Chia Jui" uniqKey="Yang C" first="Chia-Jui" last="Yang">Chia-Jui Yang</name>
<affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City</wicri:regionArea>
<wicri:noRegion>New Taipei City</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>School of Medicine, National Yang-Ming University, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>School of Medicine, National Yang-Ming University, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Tsai, Mao Song" sort="Tsai, Mao Song" uniqKey="Tsai M" first="Mao-Song" last="Tsai">Mao-Song Tsai</name>
<affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City</wicri:regionArea>
<wicri:noRegion>New Taipei City</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Liu, Chun Eng" sort="Liu, Chun Eng" uniqKey="Liu C" first="Chun-Eng" last="Liu">Chun-Eng Liu</name>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Changhua Christian Hospital, Changhua</wicri:regionArea>
<wicri:noRegion>Changhua</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lee, Yuan Ti" sort="Lee, Yuan Ti" uniqKey="Lee Y" first="Yuan-Ti" last="Lee">Yuan-Ti Lee</name>
<affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>School of Medicine, Chung Shan Medical University, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>School of Medicine, Chung Shan Medical University, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff010"><addr-line>Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Tang, Hung Jen" sort="Tang, Hung Jen" uniqKey="Tang H" first="Hung-Jen" last="Tang">Hung-Jen Tang</name>
<affiliation wicri:level="1"><nlm:aff id="aff011"><addr-line>Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Chi Mei Medical Center, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff012"><addr-line>Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Wang, Ning Chi" sort="Wang, Ning Chi" uniqKey="Wang N" first="Ning-Chi" last="Wang">Ning-Chi Wang</name>
<affiliation wicri:level="1"><nlm:aff id="aff013"><addr-line>Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lin, Te Yu" sort="Lin, Te Yu" uniqKey="Lin T" first="Te-Yu" last="Lin">Te-Yu Lin</name>
<affiliation wicri:level="1"><nlm:aff id="aff013"><addr-line>Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lee, Yi Chien" sort="Lee, Yi Chien" uniqKey="Lee Y" first="Yi-Chien" last="Lee">Yi-Chien Lee</name>
<affiliation wicri:level="1"><nlm:aff id="aff014"><addr-line>Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi</wicri:regionArea>
<wicri:noRegion>Chia-Yi</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lin, Shih Ping" sort="Lin, Shih Ping" uniqKey="Lin S" first="Shih-Ping" last="Lin">Shih-Ping Lin</name>
<affiliation wicri:level="1"><nlm:aff id="aff015"><addr-line>Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Taichung Veterans General Hospital, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Huang, Yu Shan" sort="Huang, Yu Shan" uniqKey="Huang Y" first="Yu-Shan" last="Huang">Yu-Shan Huang</name>
<affiliation wicri:level="1"><nlm:aff id="aff016"><addr-line>Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu</wicri:regionArea>
<wicri:noRegion>Hsin-Chu</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zhang, Jun Yu" sort="Zhang, Jun Yu" uniqKey="Zhang J" first="Jun-Yu" last="Zhang">Jun-Yu Zhang</name>
<affiliation wicri:level="1"><nlm:aff id="aff017"><addr-line>Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Center of Infection Control, National Taiwan University Hospital, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ko, Wen Chien" sort="Ko, Wen Chien" uniqKey="Ko W" first="Wen-Chien" last="Ko">Wen-Chien Ko</name>
<affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, National Cheng Kung University Hospital, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Medicine, National Cheng Kung University Medical College, Tainan</wicri:regionArea>
<wicri:noRegion>Tainan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Cheng, Shu Hsing" sort="Cheng, Shu Hsing" uniqKey="Cheng S" first="Shu-Hsing" last="Cheng">Shu-Hsing Cheng</name>
<affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City</wicri:regionArea>
<wicri:noRegion>Taoyuan City</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff018"><addr-line>School of Public Health, Taipei Medical University, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>School of Public Health, Taipei Medical University, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
<affiliation wicri:level="1"><nlm:aff id="aff019"><addr-line>Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff020"><addr-line>Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Parasitology, National Taiwan University College of Medicine, Taipei</wicri:regionArea>
<wicri:noRegion>Taipei</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff021"><addr-line>Department of Medical Research, China Medical University Hospital, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Department of Medical Research, China Medical University Hospital, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff022"><addr-line>China Medical University, Taichung, Taiwan</addr-line>
</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>China Medical University, Taichung</wicri:regionArea>
<wicri:noRegion>Taichung</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Objectives</title>
<p>The international and national HIV treatment guidelines in 2016 have focused on scaling up access to combination antiretroviral therapy (cART). We aimed to assess the trends and treatment outcomes of late cART initiation in Taiwan.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>Between June 2012 and May 2016, we retrospectively included antiretroviral-naive HIV-positive adults who initiated cART. Late initiation was defined as when cART was initiated in patients with a CD4 count <200 cells/mm<sup>3</sup>
 or having experienced AIDS-defining illnesses. The treatment outcomes were assessed up to 6 months after starting cART.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>We included 3655 HIV-positive patients, and the majority of the patients were male (95.4%) with a median age of 31 years and initiated non-nucleoside reverse-transcriptase inhibitor-containing regimens (87.0%). The median CD4 count at cART initiation increased from 207 cells/mm<sup>3</sup>
 in 2012 to 298 cells/mm<sup>3</sup>
 in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (<italic>P</italic>
 for trend <0.001). Late cART initiation mainly resulted from late presentation for HIV care and was associated with older age (per 1-year increase, adjusted odds ratio [AOR], 1.05; 95% CI, 1.04–1.06), HBsAg seropositivity (AOR, 1.31; 95% CI, 1.04–1.64), HIV care in central and southern Taiwan, initiating cART in earlier year, non-intravenous drug users (AOR, 1.96; 95% CI, 1.33–2.86), and negative hepatitis C serostatus (AOR, 1.47; 95% CI, 1.04–2.08). Compared with non-late initiators, late initiators had a higher rate of all-cause mortality (1.7% vs. 0.3%) and regimen modification due to virological failure (7.1% vs. 2.6%). The predicting factors of all-cause mortality were late cART initiation (adjusted hazard ratio [AHR], 5.40; 95% CI, 2.14–13.65) and older age (AHR, 1.06; 95% CI, 1.03–1.10).</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>While the proportion of late cART initiation decreased over time in Taiwan, late initiation remained in a substantial proportion of HIV-positive patients. The late initiators had higher risk for poor outcomes. The need for strategies to earlier detection of HIV infection and expediting cART initiation should be highlighted, especially among the older population.</p>
</sec>
</div>
</front>
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</TEI>
<affiliations><list><country><li>Taïwan</li>
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</list>
<tree><country name="Taïwan"><noRegion><name sortKey="Lin, Kuan Yin" sort="Lin, Kuan Yin" uniqKey="Lin K" first="Kuan-Yin" last="Lin">Kuan-Yin Lin</name>
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<name sortKey="Huang, Yu Shan" sort="Huang, Yu Shan" uniqKey="Huang Y" first="Yu-Shan" last="Huang">Yu-Shan Huang</name>
<name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
<name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
<name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
<name sortKey="Hung, Chien Ching" sort="Hung, Chien Ching" uniqKey="Hung C" first="Chien-Ching" last="Hung">Chien-Ching Hung</name>
<name sortKey="Ko, Wen Chien" sort="Ko, Wen Chien" uniqKey="Ko W" first="Wen-Chien" last="Ko">Wen-Chien Ko</name>
<name sortKey="Ko, Wen Chien" sort="Ko, Wen Chien" uniqKey="Ko W" first="Wen-Chien" last="Ko">Wen-Chien Ko</name>
<name sortKey="Lee, Yi Chien" sort="Lee, Yi Chien" uniqKey="Lee Y" first="Yi-Chien" last="Lee">Yi-Chien Lee</name>
<name sortKey="Lee, Yuan Ti" sort="Lee, Yuan Ti" uniqKey="Lee Y" first="Yuan-Ti" last="Lee">Yuan-Ti Lee</name>
<name sortKey="Lee, Yuan Ti" sort="Lee, Yuan Ti" uniqKey="Lee Y" first="Yuan-Ti" last="Lee">Yuan-Ti Lee</name>
<name sortKey="Li, Chia Wen" sort="Li, Chia Wen" uniqKey="Li C" first="Chia-Wen" last="Li">Chia-Wen Li</name>
<name sortKey="Li, Chia Wen" sort="Li, Chia Wen" uniqKey="Li C" first="Chia-Wen" last="Li">Chia-Wen Li</name>
<name sortKey="Lin, Shih Ping" sort="Lin, Shih Ping" uniqKey="Lin S" first="Shih-Ping" last="Lin">Shih-Ping Lin</name>
<name sortKey="Lin, Te Yu" sort="Lin, Te Yu" uniqKey="Lin T" first="Te-Yu" last="Lin">Te-Yu Lin</name>
<name sortKey="Liu, Chun Eng" sort="Liu, Chun Eng" uniqKey="Liu C" first="Chun-Eng" last="Liu">Chun-Eng Liu</name>
<name sortKey="Tang, Hung Jen" sort="Tang, Hung Jen" uniqKey="Tang H" first="Hung-Jen" last="Tang">Hung-Jen Tang</name>
<name sortKey="Tang, Hung Jen" sort="Tang, Hung Jen" uniqKey="Tang H" first="Hung-Jen" last="Tang">Hung-Jen Tang</name>
<name sortKey="Tsai, Mao Song" sort="Tsai, Mao Song" uniqKey="Tsai M" first="Mao-Song" last="Tsai">Mao-Song Tsai</name>
<name sortKey="Wang, Ning Chi" sort="Wang, Ning Chi" uniqKey="Wang N" first="Ning-Chi" last="Wang">Ning-Chi Wang</name>
<name sortKey="Yang, Chia Jui" sort="Yang, Chia Jui" uniqKey="Yang C" first="Chia-Jui" last="Yang">Chia-Jui Yang</name>
<name sortKey="Yang, Chia Jui" sort="Yang, Chia Jui" uniqKey="Yang C" first="Chia-Jui" last="Yang">Chia-Jui Yang</name>
<name sortKey="Zhang, Jun Yu" sort="Zhang, Jun Yu" uniqKey="Zhang J" first="Jun-Yu" last="Zhang">Jun-Yu Zhang</name>
</country>
</tree>
</affiliations>
</record>

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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up

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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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