title: Timing of antiretroviral therapy initiation after a first AIDS-defining event: temporal changes in clinical attitudes in the ICONA cohort.
abstract: BACKGROUND
  Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE.
  
  
  METHODS
  All HIV+ persons diagnosed with an ADE over the 6 months prior to or after enrolment in the Icona Foundation study cohort and while ART-naive were grouped according to type of diagnosis: Those with ADE requiring medications interacting with ART [group A], those with ADE treatable only with ART [B] and other ADE [C]. Survival analysis by Kaplan-Meier was used to estimate the percentage of people starting ART, overall and after stratification for calendar period and ADE group. Multivariable Cox regression model was used to investigate association between calendar year of specific ADE and time to ART initiation.
  
  
  RESULTS
  720 persons with first ADE were observed over 1996-2013 (group A, n=171; B, n=115; C, n=434). By 30 days from diagnosis, 27% (95% CI: 22-32) of those diagnosed in 1996-2000 had started ART vs. 32% (95% CI: 24-40) in 2001-2008 and 43% (95% CI: 33-47) after 2008 (log-rank p=0.001). The proportion of patients starting ART by 30 days was 13% (95% CI 7-19), 40% (95% CI: 30-50) and 38% (95% CI 33-43) in ADE groups A, B and C (log-rank p=0.0001). After adjustment for potential confounders, people diagnosed after 2008 remained at increased probability of starting ART more promptly than those diagnosed in 1996-1999 (AHR 1.72 (95% CI 1.16-2.56).
  
  
  CONCLUSIONS
  In our "real-life" setting, the time from ADE to ART initiation was significantly shorter in people diagnosed in more recent years, although perhaps less prompt than expected.
authors.affiliation: Department of Public Health, Institute of Infectious Diseases, Catholic University, Roma, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cingolani
authors.affiliation: Research Department of Infection & Population Health, University College London, London, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.affiliation: Clinical Department, National Institute for Infectious Diseases "L. Spallanzani," Roma, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
authors.affiliation: Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.affiliation: Department of Infectious Diseases, S. Maria Nuova IRCCS Hospital, Reggio Emilia, Italy.
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Ursitti
authors.affiliation: Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caramello
authors.affiliation: Department of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Angarano
authors.affiliation: Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonfanti
authors.affiliation: Department of Internal and Specialty Medicine, University Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.affiliation: Department of Infectious Diseases, University of Sassari, Sassari, Italy.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Mura
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases "L. Spallanzani," Roma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.affiliation: Clinical Department, National Institute for Infectious Diseases "L. Spallanzani," Roma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.affiliation: Department of Medicine, Surgery and Dentistry University of Milan Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy.
authors.forename: Antonela D'Arminio
authors.initials: AD
authors.lastname: Monforte
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents