Cescon Angela, Patterson Sophie, Davey Colin, Ding Erin, Raboud Janet M, Chan Keith, Loutfy Mona R, Cooper Curtis, Burchell Ann N, Palmer Alexis K, Tsoukas Christos, Machouf Nima, Klein Marina B, Rourke Sean B, Rachlis Anita, Hogg Robert S, Montaner Julio S G
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Northern Ontario School of Medicine, Sudbury, Canada.
J Int AIDS Soc. 2015 Oct 5;18(1):20024. doi: 10.7448/IAS.18.1.20024. eCollection 2015.
Combination antiretroviral therapy (ART) significantly decreases morbidity, mortality and HIV transmission. We aimed to characterize the timing of ART initiation based on CD4 cell count from 2000 to 2012 and identify factors associated with late initiation of treatment.
Participants from the Canadian Observational Cohort (CANOC), a multi-site cohort of HIV-positive adults initiating ART naively after 1 January 2000, in three Canadian provinces (British Columbia, Ontario and Québec) were included. Late initiation was defined as a CD4 count <200 cells/mm(3) or an AIDS-defining illness before ART initiation (baseline). Temporal trends were assessed using the Cochran-Armitage test, and independent correlates of late initiation were identified using logistic regression.
In total, 8942 participants (18% female) of median age 40 years (Q1-Q3 33-47) were included. The median baseline CD4 count increased from 190 cells/mm(3) (Q1-Q3 80-320) in 2000 to 360 cells/mm(3) (Q1-Q3 220-490) in 2012 (p<0.001). Overall, 4274 participants (48%) initiated ART with a CD4 count <200 cells/mm(3) or AIDS-defining illness. Late initiation was more common among women, non-MSM, older individuals, participants from Ontario and BC (vs. Québec), persons with injection drug use (IDU) history and individuals starting ART in earlier calendar years. In sub-analysis exploring recent (2008 to 2012) predictors using an updated CD4 criterion (<350 cells/mm(3)), IDU and residence in BC (vs. Québec) were no longer significant correlates of late initiation.
This analysis documents increasing baseline CD4 counts over time among Canadians initiating ART. However, CD4 counts at ART initiation remain below contemporary treatment guidelines, highlighting the need for strategies to improve earlier engagement in HIV care.
联合抗逆转录病毒疗法（ART）可显著降低发病率、死亡率及HIV传播率。我们旨在根据2000年至2012年的CD4细胞计数来描述ART起始时间特征，并确定与延迟开始治疗相关的因素。
纳入来自加拿大观察性队列（CANOC）的参与者，该队列是2000年1月1日后在加拿大三个省份（不列颠哥伦比亚省、安大略省和魁北克省）首次接受ART治疗的HIV阳性成人多中心队列。延迟开始治疗定义为在ART起始（基线）前CD4计数<200个细胞/mm³或患有艾滋病定义疾病。使用 Cochr an - Armitage检验评估时间趋势，并使用逻辑回归确定延迟开始治疗的独立相关因素。
共纳入8942名参与者（18%为女性），中位年龄40岁（第一四分位数 - 第三四分位数为33 - 47岁）。基线CD4计数中位数从2000年的190个细胞/mm³（第一四分位数 - 第三四分位数为80 - 320）增加到2012年的360个细胞/mm³（第一四分位数 - 第三四分位数为220 - 490）（p<0.001）。总体而言，4274名参与者（48%）在CD4计数<200个细胞/mm³或患有艾滋病定义疾病时开始接受ART治疗。延迟开始治疗在女性、非男男性行为者、年龄较大者、来自安大略省和不列颠哥伦比亚省的参与者（与魁北克省相比）、有注射吸毒（IDU）史者以及在较早日历年份开始接受ART治疗的个体中更为常见。在使用更新的CD4标准（<350个细胞/mm³）探索近期（2008年至2012年）预测因素的亚分析中，IDU和居住在不列颠哥伦比亚省（与魁北克省相比）不再是延迟开始治疗的显著相关因素。
该分析表明，随着时间推移，开始接受ART治疗的加拿大人的基线CD4计数有所增加。然而，ART起始时的CD4计数仍低于当代治疗指南，这凸显了制定策略以促进更早参与HIV治疗的必要性。
