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Time to HAART initiation after diagnosis and treatment of opportunistic infections in patients with AIDS in Latin America

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dc.contributor.author Crabtree-Ramírez, B.
dc.contributor.author Caro-Vega, Y.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Grinsztejn, B.
dc.contributor.author Wolff, M.
dc.contributor.author Cortes, C.P.
dc.contributor.author Padgett, D.
dc.contributor.author Carriquiry, G.
dc.contributor.author Fink, V.
dc.contributor.author Jayathilake, K.
dc.contributor.author Person, A.K.
dc.contributor.author McGowan, C.
dc.contributor.author Sierra-Madero, J.
dc.contributor.author CCASAnet
dc.date.accessioned 2019-04-24T18:23:56Z
dc.date.available 2019-04-24T18:23:56Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/6489
dc.description.abstract Background: Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in "real life" settings in Latin America has not been evaluated. Methods: Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCA-SAnet) ≥18 years of age at enrolment, from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. Results: A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1) weeks before 2009 to 4.3 (IQR 2.0-7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001). Discussion: The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices, local guidelines, and access to HAART. The impact of the timing of HAART initiation after OI on patient survival in this "real life" context needs further evaluation. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS ONE
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject CD4 antigen en_US
dc.subject nonnucleoside reverse transcriptase inhibitor en_US
dc.subject proteinase inhibitor en_US
dc.subject acquired immune deficiency syndrome en_US
dc.subject adult en_US
dc.subject Argentina en_US
dc.subject Article en_US
dc.subject atypical mycobacteriosis en_US
dc.subject brain disease en_US
dc.subject Brazil en_US
dc.subject Caribbean en_US
dc.subject CD4 lymphocyte count en_US
dc.subject Central America en_US
dc.subject Chile en_US
dc.subject coccidioidomycosis en_US
dc.subject cohort analysis en_US
dc.subject controlled study en_US
dc.subject cryptococcal meningitis en_US
dc.subject cryptosporidiosis en_US
dc.subject cytomegalovirus infection en_US
dc.subject Cytomegalovirus retinitis en_US
dc.subject female en_US
dc.subject follow up en_US
dc.subject herpes simplex en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject histoplasmosis en_US
dc.subject Honduras en_US
dc.subject human en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject invasive candidiasis en_US
dc.subject isosporiasis en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject Mexico en_US
dc.subject opportunistic infection en_US
dc.subject Pneumocystis pneumonia en_US
dc.subject prevalence en_US
dc.subject progressive multifocal leukoencephalopathy en_US
dc.subject salmonellosis en_US
dc.subject South America en_US
dc.subject South and Central America en_US
dc.subject therapy delay en_US
dc.subject toxoplasmosis en_US
dc.subject tuberculosis en_US
dc.subject AIDS-Related Opportunistic Infections en_US
dc.subject clinical trial en_US
dc.subject disease free survival en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject Human immunodeficiency virus 1 en_US
dc.subject mortality en_US
dc.subject multicenter study en_US
dc.subject survival rate en_US
dc.subject time factor en_US
dc.subject Adult en_US
dc.subject AIDS-Related Opportunistic Infections en_US
dc.subject Antiretroviral Therapy, Highly Active en_US
dc.subject Disease-Free Survival en_US
dc.subject Female en_US
dc.subject HIV-1 en_US
dc.subject Humans en_US
dc.subject Latin America en_US
dc.subject Male en_US
dc.subject Prevalence en_US
dc.subject Survival Rate en_US
dc.subject Time Factors en_US
dc.title Time to HAART initiation after diagnosis and treatment of opportunistic infections in patients with AIDS in Latin America en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0153921
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.05
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1932-6203


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