Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain.
Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Lancet HIV. 2024 Jul;11(7):e470-e478. doi: 10.1016/S2352-3018(24)00118-8. Epub 2024 May 30.
Ending AIDS by 2030 requires improvements across all stages of the HIV care continuum. We used a longitudinal approach to assess changes in the HIV care continuum in Spain and transition probabilities across different stages.
We used data from the prospective Cohort of the Spanish HIV/AIDS Research Network to analyse the time from diagnosis to linkage to care, linkage to care to antiretroviral therapy (ART), and ART to viral suppression in five calendar periods defined by milestones in ART, from 2005 to 2022. We used the Kaplan-Meier method and Cox proportional hazard models to estimate cumulative probabilities of stage transition within 1, 3, 6, and 12 months of stage eligibility, by period.
We included 18 529 participants. Comparing the initial (2005-09) and final (2020-22) periods, time to linkage to care decreased from a median of 6·0 weeks to 1·3 weeks, time to ART initiation from 15·9 weeks to 0·4 weeks, and time to viral suppression from 13·3 weeks to 7·1 weeks. Adjusted hazard ratios for the comparison between the last period and the initial period were 3·1 (95% CI 2·8-3·4) for linkage to care within 1 month, 11·4 (10·1-12·3) for ART initiation within 1 month, and 2·2 (1·2-2·4) for viral suppression within 3 months. The aggregate proportion of late diagnoses was 38·6%, increasing after 2012 to 46·4% in the 2020-22 period. Same-day ART initiation increased from 18% to 39% from 2005 to 2022. The overall incidence rate of virological failure was 1·05 failures per 1000 person-years and showed a non-significant decline throughout the study.
The great improvement in transition times through the HIV care cascade might put Spain on the verge of achieving the UNAIDS targets for HIV elimination. However, late diagnosis remains a challenge that should be addressed.
Instituto de Salud Carlos III and Spanish AIDS Research Network.
到 2030 年终结艾滋病需要在艾滋病毒护理连续体的所有阶段都有所改进。我们采用纵向方法评估了西班牙艾滋病毒护理连续体的变化以及不同阶段之间的转移概率。
我们使用西班牙艾滋病毒/艾滋病研究网络前瞻性队列的数据，分析了五个不同时期（根据抗逆转录病毒治疗里程碑定义）从诊断到获得护理、获得护理到开始抗逆转录病毒治疗以及开始抗逆转录病毒治疗到病毒抑制的时间，这五个时期为 2005 年至 2022 年。我们使用 Kaplan-Meier 方法和 Cox 比例风险模型按时期估计在符合阶段条件后 1、3、6 和 12 个月内阶段转移的累积概率。
我们纳入了 18529 名参与者。与初始（2005-09 年）和最终（2020-22 年）时期相比，获得护理的时间从中位数 6.0 周缩短至 1.3 周，开始抗逆转录病毒治疗的时间从 15.9 周缩短至 0.4 周，病毒抑制的时间从 13.3 周缩短至 7.1 周。最后一个时期与初始时期相比，1 个月内获得护理的调整后风险比为 3.1（95%CI 2.8-3.4），1 个月内开始抗逆转录病毒治疗的调整后风险比为 11.4（10.1-12.3），3 个月内病毒抑制的调整后风险比为 2.2（1.2-2.4）。晚期诊断的总比例为 38.6%，2012 年后增加到 2020-22 年的 46.4%。同日开始抗逆转录病毒治疗的比例从 2005 年的 18%增加到 2022 年的 39%。病毒学失败的总发生率为每 1000 人年 1.05 例失败，整个研究期间呈非显著下降趋势。
艾滋病毒护理连续体中过渡时间的巨大改善可能使西班牙即将实现联合国艾滋病规划署消除艾滋病毒的目标。然而，晚期诊断仍然是一个挑战，需要加以解决。
西班牙卡洛斯三世卫生研究所和西班牙艾滋病研究网络。
