PMID- 29412520
OWN - NLM
STAT- MEDLINE
DCOM- 20190521
LR  - 20240315
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 21
IP  - 2
DP  - 2018 Feb
TI  - Socio-economic status and time trends associated with early ART initiation 
      following primary HIV infection in Montreal, Canada: 1996 to 2015.
LID - 10.1002/jia2.25034 [doi]
LID - e25034
AB  - INTRODUCTION: Guidelines regarding antiretroviral therapy (ART) initiation in HIV 
      infection have varied over time, with the 2015 World Health Organization 
      recommendation suggesting ART initiation at the time of diagnosis regardless of 
      CD4 T-cell counts. Herein, we investigated the influence of socio-demographic and 
      clinical factors in addition to time trends on early ART initiation among 
      participants of the Montreal Primary HIV Infection Study. METHODS: The Montreal 
      Primary HIV Infection Study is a prospective cohort established in three 
      community medical centres (CMCs) and two university medical centres (UMCs). 
      Recently diagnosed HIV-infected adults were categorized as receiving early (vs. 
      delayed) ART if ART was initiated within 180 days of the baseline visit. 
      Associations between early ART initiation and socio-demographic, socio-economic 
      and behavioural information were examined. Independent associations of factors 
      linked with early ART initiation were determined using multivariable binary 
      logistic regression analysis. RESULTS: A total of 348 participants had a 
      documented date of HIV acquisition of <180 days. The median interquartile range 
      (IQR) age of participants was 35 (28; 42) years and the majority were male (96%), 
      having paid employment (63%), men who have sex with men (MSM) (78%) and one to 
      four sexual partners in the last three months (70%). Participants presented with 
      a median IQR HIV plasma viral load of 4.6 (3.7; 5.3) log(10) copies/ml, CD4 count 
      of 510 (387; 660) cells/mul and were recruited in CMCs (52%) or UMCs (48%). Early 
      ART initiation was observed in 47% of the participants and the trend followed a 
      V-shaped curve with peaks in 1996 to 1997 (89%) and 2013 to 2015 (88%) with a dip 
      in 2007 to 2009 (22%). Multivariable analyses showed that having a paid 
      employment adjusted odds ratio (aOR: 2.43; 95% CI: 1.19, 4.95), lower CD4 count 
      (aOR per 50 cell increase: 0.93; 95% CI: 0.87, 0.99) and care at UMCs (aOR: 2.03; 
      95% CI: 1.06 to 3.90) were independently associated with early ART initiation. 
      CONCLUSIONS: Early ART initiation during primary HIV infection was associated 
      with diminished biological prognostic factors and calendar time mirroring 
      evolution of treatment guidelines. In addition, socio-economic factors such as 
      having a paid employment, contribute to early ART initiation in the context of 
      universal access to care in Canada.
CI  - (c) 2018 The Authors. Journal of the International AIDS Society published by John 
      Wiley & sons Ltd on behalf of the International AIDS Society.
FAU - Mehraj, Vikram
AU  - Mehraj V
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
FAU - Cox, Joseph
AU  - Cox J
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
AD  - Department of Epidemiology, Biostatistics and Occupational Health, McGill 
      University, Montreal, QC, Canada.
FAU - Lebouche, Bertrand
AU  - Lebouche B
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
AD  - Department of Family Medicine, McGill University, Montreal, QC, Canada.
FAU - Costiniuk, Cecilia
AU  - Costiniuk C
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
FAU - Cao, Wei
AU  - Cao W
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
AD  - Department of Infectious Diseases, Peking Union Medical College Hospital, 
      Beijing, China.
FAU - Li, Taisheng
AU  - Li T
AD  - Department of Infectious Diseases, Peking Union Medical College Hospital, 
      Beijing, China.
FAU - Ponte, Rosalie
AU  - Ponte R
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
FAU - Thomas, Rejean
AU  - Thomas R
AD  - Clinique Medicale l'Actuel, Montreal, QC, Canada.
FAU - Szabo, Jason
AU  - Szabo J
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Clinique Medicale l'Actuel, Montreal, QC, Canada.
FAU - Baril, Jean-Guy
AU  - Baril JG
AD  - Clinique Medicale Quartier Latin, Montreal, QC, Canada.
FAU - Trottier, Benoit
AU  - Trottier B
AD  - Clinique Medicale Quartier Latin, Montreal, QC, Canada.
FAU - Cote, Pierre
AU  - Cote P
AD  - Clinique Medicale Quartier Latin, Montreal, QC, Canada.
FAU - LeBlanc, Roger
AU  - LeBlanc R
AD  - Clinique Medicale OPUS, Montreal, QC, Canada.
FAU - Bruneau, Julie
AU  - Bruneau J
AD  - Centre de recherche du Centre Hospitalier de l', Universite de Montreal, 
      Montreal, QC, Canada.
FAU - Tremblay, Cecile
AU  - Tremblay C
AD  - Centre de recherche du Centre Hospitalier de l', Universite de Montreal, 
      Montreal, QC, Canada.
AD  - Departement de microbiologie infectiologie et immunologie, Universite de 
      Montreal, Montreal, QC, Canada.
FAU - Routy, Jean-Pierre
AU  - Routy JP
AUID- ORCID: 0000-0001-9897-7589
AD  - Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, 
      Canada.
AD  - Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
AD  - Division of Hematology, McGill University Health Centre, Montreal, QC, Canada.
CN  - Montreal Primary HIV-Infection Study Group
LA  - eng
GR  - MOP 103230/CIHR/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - HIV Infections/*drug therapy/immunology
MH  - Humans
MH  - Male
MH  - Prospective Studies
MH  - Social Class
MH  - Time Factors
PMC - PMC5804015
OTO - NOTNLM
OT  - CD4 count
OT  - guidelines for the use of antiretroviral therapy
OT  - primary HIV infection
OT  - socio-demographic factors
OT  - socio-economic factors
OT  - time trends
OT  - universal access to care
FIR - Charest, L
IR  - Charest L
FIR - Milne, C
IR  - Milne C
FIR - Lavoie, S
IR  - Lavoie S
FIR - Friedman, J
IR  - Friedman J
FIR - Duchastel, M
IR  - Duchastel M
FIR - Villielm, F
IR  - Villielm F
FIR - Asselin, F
IR  - Asselin F
FIR - Boissonnault, M
IR  - Boissonnault M
FIR - Maziade, P J
IR  - Maziade PJ
FIR - Milne, M
IR  - Milne M
FIR - Lessard, B
IR  - Lessard B
FIR - Charron, M A
IR  - Charron MA
FIR - Dufresne, S
IR  - Dufresne S
FIR - Turgeon, M E
IR  - Turgeon ME
FIR - Vezina, S
IR  - Vezina S
FIR - Huchet, E
IR  - Huchet E
FIR - Kerba, J P
IR  - Kerba JP
FIR - Poliquin, M
IR  - Poliquin M
FIR - Poulin, S
IR  - Poulin S
FIR - Rochette, P
IR  - Rochette P
FIR - Junod, P
IR  - Junod P
FIR - Longpre, D
IR  - Longpre D
FIR - Pilarski, R
IR  - Pilarski R
FIR - Sasseville, E
IR  - Sasseville E
FIR - Labrecque, L
IR  - Labrecque L
FIR - Fortin, C
IR  - Fortin C
FIR - Hal-Gagne, V
IR  - Hal-Gagne V
FIR - Munoz, M
IR  - Munoz M
FIR - Deligne, B
IR  - Deligne B
FIR - Martel-Laferriere, V
IR  - Martel-Laferriere V
FIR - Goyer, M E
IR  - Goyer ME
FIR - Gilmore, N
IR  - Gilmore N
FIR - Potter, M
IR  - Potter M
FIR - Klein, M
IR  - Klein M
FIR - Teltscher, M
IR  - Teltscher M
FIR - de Pokomandy, A
IR  - de Pokomandy A
FIR - Haraoui, L P
IR  - Haraoui LP
FIR - Rivet, Nathalie
IR  - Rivet N
FIR - Nguyen, Tuyen
IR  - Nguyen T
FIR - Bernard, Nicole
IR  - Bernard N
FIR - Dupuy, Franck
IR  - Dupuy F
FIR - Cohen, Eric A
IR  - Cohen EA
FIR - Ancuta, Petronela
IR  - Ancuta P
FIR - Roger, Michel
IR  - Roger M
FIR - Wainberg, Mark A
IR  - Wainberg MA
FIR - Brenner, Bluma G
IR  - Brenner BG
EDAT- 2018/02/08 06:00
MHDA- 2019/05/22 06:00
PMCR- 2018/02/07
CRDT- 2018/02/08 06:00
PHST- 2017/06/01 00:00 [received]
PHST- 2017/11/17 00:00 [accepted]
PHST- 2018/02/08 06:00 [entrez]
PHST- 2018/02/08 06:00 [pubmed]
PHST- 2019/05/22 06:00 [medline]
PHST- 2018/02/07 00:00 [pmc-release]
AID - JIA225034 [pii]
AID - 10.1002/jia2.25034 [doi]
PST - ppublish
SO  - J Int AIDS Soc. 2018 Feb;21(2):e25034. doi: 10.1002/jia2.25034.