TY - JOUR
TI - HIV continuum of care: Bridging cross-sectional and longitudinal analyses
AU - Touloumi, G.
AU - Thomadakis, C.
AU - Pantazis, N.
AU - Papastamopoulos, V.
AU - Paparizos, V.
AU - Metallidis, S.
AU - Adamis, G.
AU - Chini, M.
AU - Psichogiou, M.
AU - Chrysos, G.
AU - Sambatakou, H.
AU - Barbunakis, E.
AU - Vourli, G.
AU - Antoniadou, A.
AU - Lazanas, M.
AU - Papastamopoulos, V.
AU - Paraskevis, D.
AU - Touloumi, G.
AU - Papadopoulos, A.
AU - Nitsotolis, T.
AU - Basoulis, D.
AU - Astriti, M.
AU - Gogos, H.A.
AU - Marangos, M.N.
AU - Katsarou, O.
AU - Kouramba, A.
AU - Sipsas, N.V.
AU - Kontos, A.
AU - Lioni, A.
AU - Tsachouridou, O.
AU - Paparizos, V.
AU - Kourkounti, S.
AU - Papastamopoulos, V.
AU - Panagopoulos, P.
AU - Ganitis, A.
AU - Gikas, A.
AU - Barbounakis, E.
AU - Gogos, H.
AU - the AMACS
JO - Ελληνικά Αρχεία AIDS=:  Hellenic Archives of AIDS
PY - 2022
VL - 36
TODO - 4
SP - 583-591
PB - Lippincott Williams and Wilkins
SN - 11058900
TODO - 10.1097/QAD.0000000000003131
TODO - article;  cohort analysis;  controlled study;  cumulative incidence;  diagnosis;  diagnosis time;  early diagnosis;  follow up;  human;  Human immunodeficiency virus;  Human immunodeficiency virus infected patient;  multicenter study;  nonhuman;  rebound;  virus load
TODO - Objective: The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages. Design: The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability. Methods: Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-followup (LTFU) as competing event. Viral suppression was defined as viral load less than 500 copies/ml. Viral suppression durability was assessed by the CIF of viral load rebound. Findings: About 89.1% of PWH in 2018 were diagnosed (range of diagnoses: 1980 - 2018). Median time to diagnosis was 3.5 years (IQR: 1.1 - 7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5 years since first viral suppression but substantially reduced in more recent years. Interpretation: The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
ER -