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UNAIDS endpoint, HIV, engagement in care, Foreigners
Despite progress in the prevention and treatment of HIV, persistent issues concerning the evaluation of continuum in care from the serological diagnosis to virologic success remain.
Considering the UNAIDS target 90-90-90 for 2020 for treatment and viral suppression of people living with HIV (PLVH), our purpose was to verify if, starting from diagnosis, the viral suppression rate of our cohort of new PLWH satisfied the above targets.
The aim of this retrospective study was to compare 2005-2017 data collected at the Perugia Infectious Diseases Clinic with the 2020 UNAIDS 90 targets and to identify risk factors that could be associated with failure to reach these targets.
Methods: We included all patients aged ?15 undergoing HIV test at our clinic between January 2005 and December 2017. We evaluated the unclaimed tests, linkage to care, retention in ART and the viral suppression at 1 and 2 years from starting ART. Data were analyzed between Italians and foreigners.
Results: We observed 592 new diagnoses for HIV infection: 61.4% on Italian-natives, 38.5% on foreigners. Considering the continuum of care from diagnosis, 88 (15%) PLWHIV were lost to engagement in care: 55 (9.2%) patients didn’t withdraw the test and 33 (5.5%) didn’t link to care.
An antiretroviral treatment was started only on 78.8% of the new diagnoses (467/592) and a viral suppression was obtained at 2 years on 82% of PLWH who had started ART (383/467) namely only 64.7% of the new diagnoses instead of the hoped-for 81% of the UNAIDS target. We found no significant differences between Italians and foreigners
UNAIDS goal was very far to be reached. The main challenges were unreturned tests as well as the retention in ART. Rapid tests for a test-treat strategy and frequent phone communications in the first ART years could facilitate UNAIDS target achievement.
2. Yehia BR, Stephens-Shields AJ, Fleishman JA, Berry SA, Agwu AL, Metlay JP, Moore RD, Christopher Mathews W, Nijhawan A, Rutstein R, Gaur AH, Gebo KA; HIV Research Network. The HIV Care Continuum: Changes over Time in Retention in Care and Viral Suppression. PLoS One. 2015 Jun 18;10(6):e 0129376.
3. Centers for Disease Control and Prevention (CDC) HIV incidence: estimated annual infections in the U.S., 2008–2014. CDC Fact Sheet. 2017:1–2.
4. Mammone A, Pezzotti P, Regine V, Camoni L, Puro V, Ippolito G, Suligoi B, Girardi E. How many people are living with undiagnosed HIV infection? An estimate for Italy, based on surveillance data. AIDS. 2016 Apr 24; 30(7): 1131–1136.
5. ICONA 2014 (http//www.fondazioneicona.org/_new).
6. Saracino A, Lorenzini P, Lo Caputo S, Girardi E, Castelli F, Bonfanti P, Rusconi S, Caramello P, Abrescia N, Mussini C, Monno L, d'Arminio Monforte A. Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: data from the ICONA cohort. ICONA Foundation Study Group. Clin Microbiol Infect. 2016 Mar;22(3):288.e1-8.
7. National HIV Infection Diagnosis Surveillance System. Data from the Umbria Region, 20016-2017. (This work was carried out within the activities provided in agreement and by the specific projects of Umbria Region, in collaboration and with the scientific contribution of the Department of Medicine).
8. Kay ES, Batey DS, Mugavero MJ.The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016 Nov 8;13:35. eCollection 2016. Review.
9. Gardner EM1, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011 Mar 15;52(6):793-800. doi: 10.1093/cid/ciq243.
10. Prinapori R, Giannini B, Riccardi N, Bovis F, Giacomini M, Setti M, Viscoli C, Artioli S, Di Biagio A. Predictors of retention in care in HIV-infected patients in a large hospital cohort in Italy. Epidemiol Infect. 2018 Apr;146(5):606-611
11. Lagi F, Kiros ST, Campolmi I, Giachè S, Rogasi PG, Mazzetti M, Bartalesi F, Trotta M, Nizzoli P, Bartoloni A, Sterrantino G. Continuum of care among HIV-1 positive patients in a single center in Italy (2007-2017). Patient Prefer Adherence. 2018 Nov 30;12:2545-2551.
12. Camoni L, Raimondo M, Urciuoli R, Iacchini S, Suligoi B, Pezzotti P; the CARPHA Study Group. People diagnosed with HIV and in care in Italy in 2014: results from the second national survey. AIDS Care. 2018 Jun;30(6):760-764.
13. Floridia M, Mastroiacovo P, Tamburrini E, Tibaldi C, Todros T, Crepaldi A, Sansone M, Fiscon M, Liuzzi G, Guerra B, Vimercati A, Vichi F, Vicini I, Pinnetti C, Marconi AM, Ravizza M; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001-2011. BJOG. 2013 Nov;120(12):1466-75.
14. Parisi MR, Soldini L, Vidoni G, Clemente F, Mabellini C, Belloni T, Nozza S, Brignolo L, Negri S, Rusconi S, Schlusnus K, Dorigatti F, Lazzarin A. Cross-sectional study of community serostatus to highlight undiagnosed HIV infections with oral fluid HIV-1/2 rapid test in non-conventional settings. New Microbiol. 2013 Apr;36(2):121-32.
15. Pilcher CD, Ospina-Norvell C, Dasgupta A, Jones D, Hartogensis W, Torres S, Calderon,F, Demicco E, Geng E, Gandhi M, Havlir DV, Hatano H. The effect of same?day observed initiation of Art on HIV viral load and treatment outcomes in a US public health setting. J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):44-51.
16. Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, Sanne I, Bokaba D, Sauls C, Rohr J, Long L. Initiating antiretroviral therapy for HIV at a patient's first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016 Jun 3;13(6):e1002050
17. Coffey S, Bacchetti P, Sachdev D, Bacon O, Jones D, Ospina-Norvell C, Torres S, Lynch E, Camp C, Mercer-Slomoff R, Lee S, Christopoulos K, Pilcher C, Hsu L, Jin C, Scheer S, Havlir D, Gandhi M. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019 Apr 1;33(5):825-832.