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

Carriquiry, G.; Wolff, M.; Jayathilake, K.; Person, A.K.; Cortes, C.P.; Fink, V.; CCASAnet; Crabtree-Ramírez, B.; Sierra-Madero, J.; Caro-Vega, Y.; McGowan, C.; Shepherd, B.E.; Padgett, D.; Grinsztejn, B.

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

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