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Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort
BACKGROUND: Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE. METHODS...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937396/ https://www.ncbi.nlm.nih.gov/pubmed/24587081 http://dx.doi.org/10.1371/journal.pone.0089861 |
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author | Cingolani, Antonella Cozzi-Lepri, Alessandro Ammassari, Adriana Mussini, Cristina Ursitti, Maria Alessandra Caramello, Pietro Angarano, Gioacchino Bonfanti, Paolo De Luca, Andrea Mura, Maria Stella Girardi, Enrico Antinori, Andrea Monforte, Antonela D'Arminio |
author_facet | Cingolani, Antonella Cozzi-Lepri, Alessandro Ammassari, Adriana Mussini, Cristina Ursitti, Maria Alessandra Caramello, Pietro Angarano, Gioacchino Bonfanti, Paolo De Luca, Andrea Mura, Maria Stella Girardi, Enrico Antinori, Andrea Monforte, Antonela D'Arminio |
author_sort | Cingolani, Antonella |
collection | PubMed |
description | BACKGROUND: Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE. METHODS: All HIV+ persons diagnosed with an ADE over the 6 months prior to or after enrolment in the Icona Foundation study cohort and while ART-naive were grouped according to type of diagnosis: Those with ADE requiring medications interacting with ART [group A], those with ADE treatable only with ART [B] and other ADE [C]. Survival analysis by Kaplan-Meier was used to estimate the percentage of people starting ART, overall and after stratification for calendar period and ADE group. Multivariable Cox regression model was used to investigate association between calendar year of specific ADE and time to ART initiation. RESULTS: 720 persons with first ADE were observed over 1996–2013 (group A, n = 171; B, n = 115; C, n = 434). By 30 days from diagnosis, 27% (95% CI: 22–32) of those diagnosed in 1996–2000 had started ART vs. 32% (95% CI: 24–40) in 2001–2008 and 43% (95% CI: 33–47) after 2008 (log-rank p = 0.001). The proportion of patients starting ART by 30 days was 13% (95% CI 7–19), 40% (95% CI: 30–50) and 38% (95% CI 33–43) in ADE groups A, B and C (log-rank p = 0.0001). After adjustment for potential confounders, people diagnosed after 2008 remained at increased probability of starting ART more promptly than those diagnosed in 1996–1999 (AHR 1.72 (95% CI 1.16–2.56). CONCLUSIONS: In our “real-life” setting, the time from ADE to ART initiation was significantly shorter in people diagnosed in more recent years, although perhaps less prompt than expected. |
format | Online Article Text |
id | pubmed-3937396 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-39373962014-03-04 Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort Cingolani, Antonella Cozzi-Lepri, Alessandro Ammassari, Adriana Mussini, Cristina Ursitti, Maria Alessandra Caramello, Pietro Angarano, Gioacchino Bonfanti, Paolo De Luca, Andrea Mura, Maria Stella Girardi, Enrico Antinori, Andrea Monforte, Antonela D'Arminio PLoS One Research Article BACKGROUND: Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE. METHODS: All HIV+ persons diagnosed with an ADE over the 6 months prior to or after enrolment in the Icona Foundation study cohort and while ART-naive were grouped according to type of diagnosis: Those with ADE requiring medications interacting with ART [group A], those with ADE treatable only with ART [B] and other ADE [C]. Survival analysis by Kaplan-Meier was used to estimate the percentage of people starting ART, overall and after stratification for calendar period and ADE group. Multivariable Cox regression model was used to investigate association between calendar year of specific ADE and time to ART initiation. RESULTS: 720 persons with first ADE were observed over 1996–2013 (group A, n = 171; B, n = 115; C, n = 434). By 30 days from diagnosis, 27% (95% CI: 22–32) of those diagnosed in 1996–2000 had started ART vs. 32% (95% CI: 24–40) in 2001–2008 and 43% (95% CI: 33–47) after 2008 (log-rank p = 0.001). The proportion of patients starting ART by 30 days was 13% (95% CI 7–19), 40% (95% CI: 30–50) and 38% (95% CI 33–43) in ADE groups A, B and C (log-rank p = 0.0001). After adjustment for potential confounders, people diagnosed after 2008 remained at increased probability of starting ART more promptly than those diagnosed in 1996–1999 (AHR 1.72 (95% CI 1.16–2.56). CONCLUSIONS: In our “real-life” setting, the time from ADE to ART initiation was significantly shorter in people diagnosed in more recent years, although perhaps less prompt than expected. Public Library of Science 2014-02-27 /pmc/articles/PMC3937396/ /pubmed/24587081 http://dx.doi.org/10.1371/journal.pone.0089861 Text en © 2014 Cingolani et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Cingolani, Antonella Cozzi-Lepri, Alessandro Ammassari, Adriana Mussini, Cristina Ursitti, Maria Alessandra Caramello, Pietro Angarano, Gioacchino Bonfanti, Paolo De Luca, Andrea Mura, Maria Stella Girardi, Enrico Antinori, Andrea Monforte, Antonela D'Arminio Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title | Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title_full | Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title_fullStr | Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title_full_unstemmed | Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title_short | Timing of Antiretroviral Therapy Initiation after a First AIDS-Defining Event: Temporal Changes in Clinical Attitudes in the ICONA Cohort |
title_sort | timing of antiretroviral therapy initiation after a first aids-defining event: temporal changes in clinical attitudes in the icona cohort |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937396/ https://www.ncbi.nlm.nih.gov/pubmed/24587081 http://dx.doi.org/10.1371/journal.pone.0089861 |
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