Welcome, Guest. Please login or register.
October 09, 2024, 03:48:53 am

Login with username, password and session length


Members
Stats
  • Total Posts: 774995
  • Total Topics: 66544
  • Online Today: 919
  • Online Ever: 5484
  • (June 18, 2021, 11:15:29 pm)
Users Online
Users: 1
Guests: 878
Total: 879

Welcome


Welcome to the POZ Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Do I Have HIV?” posting guidelines. Click here for posting guidelines pertaining to all other POZ community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Evidence for same-day antiretroviral therapy (ART)?  (Read 5147 times)

0 Members and 1 Guest are viewing this topic.

Online Jim Allen

  • Administrator
  • Member
  • Posts: 23,029
  • Threads: @jim16309
    • Social Media: Threads
Evidence for same-day antiretroviral therapy (ART)?
« on: August 08, 2023, 08:41:17 am »
Found this an interesting read.

Aidsmap.com article in full: https://www.aidsmap.com/news/aug-2023/immediate-art-associated-fewer-deaths-thailand-starting-week-or-two-later-may-lead

In Short:

Quote
The evidence for same-day antiretroviral therapy (ART) in terms of viral suppression, mortality, and the proportion who drop out of care is ambiguous. For instance, a study from Lesotho published in 2018 found higher rates of retention in care and viral suppression in people who started ART immediately, while a 2021 study from nearby Eswatini found lower rates of retention and viral suppression.

These studies featured 441 and 1899 people respectively. A much larger study from Thailand was presented at last month’s 12th International AIDS Society Conference on HIV Science (IAS 2023) in Brisbane. It featured all Thai adults – over a quarter of a million people – who started ART between the start of 2014, when treatment for all with HIV regardless of CD4 count was recommended, to the end of 2022. Same-day ART was recommended in national guidelines from January 2021.

The lowest mortality rate was seen in people who started ART within seven days (1.28%), compared to 2.04% in people who started more than a week but less than a month later, and just under 2.5% in people who started more than a month later.

The rate of outright viral failure – defined a having a viral load over 1000 more than six months after starting ART – was also lower in early starters, but was actually lowest in people who started one week to one month after diagnosis. Starting 1-7 days after diagnosis was associated with an annual virological failure rate 0f 2.76%; starting 8 days to a month later with a rate of 2.33%; 1-3 month later with a rate of 3.35%; and more than three months later with a rate of 3.78%.

This pattern persisted: three years after starting ART, the proportion who had had viral failure during that time was 6.9% in people who started from a week to a month after diagnosis, but 8.2% in the earliest starters, and over 10% in later starters.

In multivariate analysis, the advantage of starting early, but not too early, becomes clearer. When the findings were controlled for CD4 count at presentation and year starting, the risk of virological failure was 21% lower in people starting at months 1-3 after diagnosis compared with people who started therapy more than three months after diagnosis, 38% lower in people starting a week to a month after diagnosis, but only 13% lower in the early starters.

The proportion of people who dropped out of care was highest in early starters too. Thailand tends to have excellent retention rates and monitoring. Nonetheless the proportion of early starters who dropped out of care was 2.69% in early starters, 2.47% in one-week-to-one-month starters, but only 1.51% in people who started later.

References
Teeraananchai S et al. The impact of same-day and rapid ART initiation under the Universal Health Coverage program on HIV outcomes in Thailand. 12th IAS Conference, Brisbane. Abstract OAC0105. 2023.
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

My Instagram
Threads

Offline leatherman

  • Global Moderator
  • Member
  • Posts: 8,781
  • Google and HIV meds are Your Friends
Re: Evidence for same-day antiretroviral therapy (ART)?
« Reply #1 on: August 08, 2023, 09:52:48 am »
Quote
Nonetheless the proportion of early starters who dropped out of care was 2.69% in early starters, 2.47% in one-week-to-one-month starters, but only 1.51% in people who started later.
I could imagine these percentages have something to do with having that "touch of AIDS". Coming to grips with your own mortality usually has the consequence of making you a lot more amenable to taking care to not die - and that means adhering to daily ARVs. While not having that "come to Jesus" moment leaves people ignorant of the importance and need of adherence.

Looking at the situation from my side of the coin as a late starter (of course, I had to start late. there weren't any meds back then. oof), I can hardly understand someone diagnosed early, started on meds immediately (not having to wait until cd4s <=250, much less a week to get a prescription filled), who would intentionally drop out of care and willfully risk AIDS or death. But I do realize that factors like youth, not being used to taking daily meds, self-stigma, access to health care and medications, substance abuse, and homelessness are just some of the factors that can lead people to stopping treatment.

While the Ryan White program has used measurements like retention in care, medical visit frequency and medical visit gap to catch and hopefully stop those falling out of care, it's still sad people drop out of care and seems like more peer support, along with providing for those other disparities, could increase the retention in care rate.

Needless to say the upshot of this study seems to again confirm what we've known for a while now  - people who are diagnosed sooner and treated sooner live longer with fewer negative consequences.
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

 


Terms of Membership for these forums
 

© 2024 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.