Same Week: Feasibility of Rapid Antiretroviral Initiation in Brazil

Abstract

Background: Antiretroviral therapy (ART) is free in Brazil and indicated for all people living with HIV since December 2013 regardless of CD4 T cell count. The benefits of rapid ART include less risk of AIDS and non-AIDS conditions to the individual as well as lower transmissibility (Undetectable = Untransmittable). However, ART introduction may take months after diagnosis as an immediate treatment it is not a priority in many places. Method: We evaluated the time to loss of follow-up (LTFU) of 589 patients diagnosed in up to 6?months, stratified according to the time between diagnosis and ART initiation, as same week (SW), for those starting ART within 7?days of diagnosis, intermediate (I) between 8 and 30?days and late treatment (LT), for those treated after 31?days. Patients without ART withdrawal in the last 100?days were considered LTFU. Analysis was performed using the Cox proportional-hazards model. Results: The 589 consecutive patients admitted were stratified as SW 18% (n = 105), intermediate 20% (n = 119) and LT 62% (n = 365). The LTFU outcome was not different among strata (hazard ratio 1.02, 95%CI 0.71-1.46). However, LTFU was higher among non-Whites (hazard ratio 1.85, 95%CI 1.07-3.20) and transwomen (hazard ratio 2.97, 95%CI 1.35-6.55). Cox regression analyses adjusted for strata were associated for transwomen to stratum SW (hazard ratio 6.90, 95%CI 1.64-28.97) and for non-Whites to stratum LT (hazard ratio 2.34, 95%CI 1.30-4.22). Conclusion: Our study suggests that the rapid antiretroviral treatment is feasible in public units, without increases in LTFU for cases treated in the same week. However, special attention should be given to transwomen and non-Whites with public policies aimed at reducing racial and gender inequalities.

Keywords

• HIV-1
• antiretroviral therapy
• patient care
• lost to follow up
• retention in care