ArticleJournal of the International AIDS Society2015
Late initiation of combination antiretroviral therapy in Canada: a call for a national public health strategy to improve engagement in HIV care.
Article in Journal of the International AIDS Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 27 citations in OpenAlex.
- Factors associated with late initiation of antiretroviral therapy in Iran's HIV/AIDS surveillance data.Scientific reports · 2024Article
- Perceived Mistreatment in Health Care Settings and its Relationship with HIV Clinical Outcomes in HIV-positive People who Use Drugs in Vancouver, Canada.AIDS and behavior · 2023Article
- Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019.Infectious diseases and therapy · 2022Article
- Article
- Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study.Frontiers in public health · 2022Article
- Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment.BMC public health · 2021Article
- Late ART Initiation among adult HIV patients at university of Gondar Hospital, NorthWest Ethiopia.African health sciences · 2019Article
- Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France.Journal of the International AIDS Society · 2018Article
- Socio-economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015.Journal of the International AIDS Society · 2018Article
- Immune recovery of middle-aged HIV patients following antiretroviral therapy: An observational cohort study.Medicine · 2017Observational
- Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study.BMC infectious diseases · 2017Article
- The impact of criminalization of HIV non-disclosure on the healthcare engagement of women living with HIV in Canada: a comprehensive review of the evidence.Journal of the International AIDS Society · 2015Review
- Determinants of Late Initiation in Anti-retroviral Therapy Among HIV Positive Adult Patients in Public Health Facilities, West Guji Zone, Oromia, Ethiopia: A Case Control Study.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
18 authors at 12 institutions in 1 country.
Funding
Abstract
introductionCombination 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.
methodsParticipants 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.
resultsIn 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.
conclusionsThis 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.
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