Temporal trends from HIV diagnosis to ART initiation among adults living with HIV in the Asia–Pacific (2013–2023)

Vu T.T.; Rupasinghe D.; Khol V.; Chaiwarith R.; Tanuma J.; Kumarasamy N.; Khusuwan S.; Somia I.A.; Pujari S.; Lee M.P.; Borse R.T.; Kiertiburanakul S.; Yunihastuti E.; Azwa I.; Choi J.Y.; Chen H.P.; Ditangco R.; Avihingsanon A.; Gani Y.; Ross J.; Jiamsakul A.

Temporal trends from HIV diagnosis to ART initiation among adults living with HIV in the Asia–Pacific (2013–2023)

Issued Date

2025-12-01

Resource Type

Article

eISSN

17426405

DOI

10.1186/s12981-025-00718-8

Scopus ID

2-s2.0-86000275268

Journal Title

AIDS Research and Therapy

Volume

22

Issue

1

Rights Holder(s)

SCOPUS

Bibliographic Citation

AIDS Research and Therapy Vol.22 No.1 (2025)

Suggested Citation

Vu T.T., Rupasinghe D., Khol V., Chaiwarith R., Tanuma J., Kumarasamy N., Khusuwan S., Somia I.A., Pujari S., Lee M.P., Borse R.T., Kiertiburanakul S., Yunihastuti E., Azwa I., Choi J.Y., Chen H.P., Ditangco R., Avihingsanon A., Gani Y., Ross J., Jiamsakul A. Temporal trends from HIV diagnosis to ART initiation among adults living with HIV in the Asia–Pacific (2013–2023). AIDS Research and Therapy Vol.22 No.1 (2025). doi:10.1186/s12981-025-00718-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/106730

Title

Temporal trends from HIV diagnosis to ART initiation among adults living with HIV in the Asia–Pacific (2013–2023)

Corresponding Author(s)

Vu T.T.

Other Contributor(s)

Mahidol University

Abstract

Introduction: Data on the impact of World Health Organization (WHO)’s guideline changes and COVID-19 on ART initiation in the Asia–Pacific remain scarce. This study described temporal trends from HIV diagnosis to ART initiation from 2013 to 2023 and its associated factors. Methods: Adults (≥ 18 years) diagnosed with HIV after 2013 in a regional observational cohort were included. Fine and Gray competing risk regression examined predictors of ART initiation (≥ 3 antiretroviral medications), accounting for those lost to follow-up or deceased before treatment considered as competing risks. Results: Among 14,968 participants, most were male (70.1%), with a median age of 36 years (interquartile range [IQR]: 28–44). At HIV diagnosis, median CD4 count was 208 cells/µL (IQR: 69–395), and median viral load was 86,296 copies/mL (IQR: 13,186–392,000). Over 85% of participants had initiated ART during the study period. Median time from HIV diagnosis to ART initiation differed across years of HIV diagnosis: 51 days (2013–2015), 28 days (2016–2019), and 26 days (≥ 2020). Factors associated with shorter time to ART initiation were higher country income-level (upper-middle: sub-distribution hazard ratio [SHR] = 1.34, 95% CI: 1.28, 1.40; high: SHR = 1.35, 95% CI: 1.28, 1.43; vs. lower-middle); HIV transmission via male-to-male contact (SHR = 1.06, 95% CI: 1.02, 1.11) or injection drug use (SHR = 1.23, 95% CI: 1.09, 1.38; vs. heterosexual contact); and later years of HIV diagnosis (2016–2019: SHR = 1.33, 95% CI: 1.28, 1.38; ≥ 2020: SHR = 1.40, 95% CI: 1.33, 1.48; vs. 2013–2015). Those with higher CD4 counts had longer time to ART start (350–499 cells/µL: SHR = 0.76, 95% CI: 0.67, 0.86; > 500 cells/µL: SHR = 0.55, 95% CI: 0.49, 0.61; vs. CD4 < 200 cells/µL). Conclusion: Time to ART initiation from HIV diagnosis decreased after 2016, aligning with evolving WHO guidelines, and did not appear to be impacted by COVID-19. Optimizing treatment initiation during the treat-all era is crucial, especially among those with higher CD4 counts.

Keyword(s)

Biochemistry, Genetics and Molecular Biology
Medicine
Immunology and Microbiology

URI

https://repository.li.mahidol.ac.th/handle/123456789/106730

Collections

Scopus 2025

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