Disclosures: Crowell reports being an employee of the Henry M. Jackson Foundation for the Advancement of Military Medicine and receiving research funding from the U.S. Department of Defense and the NIH. Crowell also reports that ART for this study was donated by Gilead Sciences. Lee reports grants paid to John Hopkins from NIH during the conduct of the study. Please see the studies for all other authors’ relevant financial disclosures.
January 24, 2021
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Time from entering HIV care to ART prescription has decreased by more than 90%

Disclosures: Crowell reports being an employee of the Henry M. Jackson Foundation for the Advancement of Military Medicine and receiving research funding from the U.S. Department of Defense and the NIH. Crowell also reports that ART for this study was donated by Gilead Sciences. Lee reports grants paid to John Hopkins from NIH during the conduct of the study. Please see the studies for all other authors’ relevant financial disclosures.
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The median time between when patients enter HIV care to when they receive a prescription for ART decreased by more than 90% between 2005 and 2018, according to a study published in Clinical Infectious Diseases.

“There has been great progress in getting patients who are entering HIV care on treatment as soon as possible in the ‘treat all’ era, as shown by substantial declines in time to ART prescription and increases in CD4 count at ART prescription from 2005 to 2018,” Jennifer S. Lee, PhD, an assistant scientist in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, told Healio. “In contrast, increases in CD4 count at entry into care over the same time period were relatively modest.”

Crowell quote

Lee and colleagues examined data on patients from The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), a collaboration of 20 cohort studies of people living with HIV in the United States and Canada. They included adults aged 18 years or older enrolled in NA-ACCORD between January 2005 and December 2018. They excluded patients enrolled in studies before joining NA-ACCORD, studies from Canada and interval cohort studies.

Among 32,013 adults who entered HIV care across the U.S., the median time to ART prescription decreased from 69 to 6 days between 2005 and 2018, according to the study. Additionally, the median CD4 count upon entry to HIV care increased from 300 to 362 cells/L, whereas the median CD4 count at the time of ART prescription rose from 160 to 364 cells/L.

“Given the adverse consequences of delayed diagnosis and entry into care, our findings highlight the need for expanded HIV screening in clinical and community settings, and efficient linkage to care after diagnosis,” Lee said.

Another study published in Clinical Infectious Diseases found that new criteria for acute and early HIV infection (AEHI) can be used in diagnostic algorithms to begin ART initiation without an HIV RNA result.

“These new criteria may facilitate diagnosis, staging and immediate ART initiation during acute and early HIV infection in future research studies and clinical practice,” Trevor A. Crowell, MD, PhD, associate director of the department of epidemiology and threat assessment with the U.S. military’s HIV research program, told Healio.

Crowell and colleagues evaluated new AEHI criteria in a prospective ART initiation study. The A5354 Study enrolled adults from 30 sites in Africa, Asia and the Americas who met at least one of the six criteria. They then confirmed HIV infection and Fiebig stage with centralized testing.

A total of 195 patients were enrolled between 2017 to 2019. Of the participants, 87.7% initiated ART on the day of enrollment with the remaining 12.3% initiating ART the day after enrollment. AEHI was confirmed in 96.4% of patients, with 2% found to have chronic infection and 1.5% found to not have HIV. The Geenius assay and ARCHITECT HIV Combo correctly identified 81.2% of Fiebig stage 2 to 4 AEHI cases, and no false-positive results were observed.

“There may be barriers to utilizing these criteria in other settings, including resource-limited settings and routine clinical care centers,” Crowell said. “However, as the testing modalities used for the study become more commonplace, implementation of these criteria should become easier.”

References:

Crowell TA, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa1893.