Resumen

For newly diagnosed persons with HIV (NDP), early initiation of ART is essential in reducing morbidity and mortality and decreasing the risk of transmitting HIV. Two indicators have been proposed to monitor HIV care among NDP: the percentage of those linked to HIV medical care within 1 mo. of diagnosis (process) and the percentage of those achieving viral suppression (VS) within 3 mo. of diagnosis (outcome). We analyzed trends in both indicators in the Cohort of the Spanish AIDS Research Network (CoRIS). The data source was the CoRIS database of ART-naïve adult persons living with HIV (PLWH) recruited from 2004 to 2018. VS was defined as ever having an HIV-RNA <200 copies/mL. We used logistic regression to assess differences by sex, country of origin, age, HIV transmission category, and CD4 count at diagnosis. A total of 13,260 PLWH were enrolled in the study period; 84% males, 59% native-born Spaniards, median age 34 years, median CD4+ cell count 384 cells/uL, 58% MSM. The percentage of NDP linked to care within 1 mo. of diagnosis increased from 42% in 2004 to 71% in 2018 (Figure). The percentage of NDP achieving VS within 3 mo. of diagnosis, increased from 6% in 2004 to 35% in 2018 (Figure). The odds of achieving VS within 3 mo. of HIV diagnosis was higher among females (adjusted OR, 95%CI: 1.42, 1.20-1.69), among non-Spanish Europeans and Latin Americans compared to native-born Spaniards (1.39, 1.20-1.62 and 1.26, 1.09-1.45, respectively), and among those older than 50 years (1.28, 1.06-1.54). Opposite, the odds of achieving VS within 3 mo. of diagnosis was lower among IDU compared to MSM (0.48, 0.36-0.65) and those with CD4 counts between 200-500 cells/uL (0.59, 0.52-0.67) and CD4 counts >500 cells/uL (0.36, 0.30-0.42) compared to those with CD4 < 200 cells/uL. Progress has been made in HIV care among NDP in Spain during the 15-year analysis period, but there is still much room for improvement. The advance in the outcome indicator most likely reflects changes in treatment guidelines to offer ART to any PLWH regardless of CD4 count. These two indicators can guide our efforts to improve HIV care among NDP.