High rates of retention on ART and virological suppression in a large cohort
study from The Chilean AIDS Group
Beltran C, Zitko P, Fernandez A, Lasso M, Gonzalez A, Bernal F, ChanqueoL, Calvo M, Blackburn E, Diaz V, Carrasco A, Zuniga K, Sarmiento V, Fierro
G, Barthel E, Wilson G on behalf of Chilean Aids Cohort
Background
• The 90-90-90 UNAIDS --WHO goals aim to increase testing, linkage to care, ART initiation and virological suppression
• In Latin America PAHO reports that slightly over a third of HIV infected population reaches finally a viral load below 1,000 copies/mL
• This is due mainly to a significant gap in diagnosis and linkage to care but this gap is difficult to measure accurately
• Once patients start ART, real life rates of retention on ART and virological suppression may be obtained from large cohort studies
Source: UNAIDS special analysis, 2016
1 2015 measure derived from data reported by 15 countries, which accounted for 76% of people living with HIV in the region. 2 2015 measure derived from data reported by 21 countries. Regionally, 77% of all people on antiretroviral therapy were reported to have
received a viral load test during the reporting period.
Background
Percentage of PLH knowing their diagnostic Percentage on ART Percentage with suppressed
VL
• The aim of this study was to determine in 2016:– the rates of retention of patients initiating ART from 2012 to
2015– The rates of virological suppression among patients in control
with VL measured in 2016
Aim of the study
Materials and methods
• The Chilean AIDS Cohort prospectively follows up all patients on ART in 38 AIDS Care Centers of the Public Health System in Chile since 2001. The database includes 19,498 patients.
• An independent Ethic Committee approved the study and waived informed consent for data collection and publication provided that no private data or data allowing identification of pts were going to be used.
• Retention rates were obtained through a cohort analysis by year of ART initiation and efficacy rates by a cross sectional analysis of pts on ART with VL measured in 2016
• Analysis by age, gender year of ART initiation and city of residence were done by chi square test and Odds Ratios
Results: Retention in ART
95,9%
92,5%
89,6%
85,9%
80%
82%
84%
86%
88%
90%
92%
94%
96%
98%
12 mo 24 mo 36 mo 48 mo
Retention in ART at 12 to 48 months
Total1,057 pts initiating ART in 20121,243 pts initiating ART in 20131,288 pts initiating ART in 2014
890 pts initiating ART in 2015
Results: Retention in ART by gender
96,3%
92,7%90,4%
87,1%
93,9%91,5%
85,4%
80,4%
70%
75%
80%
85%
90%
95%
100%
12 mo 24 mo 36 mo 48 mo
Retention in ART by gender
Men Women
(p=0.02 OR 1.64)
(p=0.3 OR 1.68)
(p=0.6 OR 1.18 )
(p= 0.047 OR 1.61 )
Results: Virological suppression by gender
0%
20%
40%
60%
80%
100%
Total Hombres Mujeres
<50 50 - 1,000 > 1,000
90,5% 91,2%86,4% VL< 1,000 (p<0.001 OR 1.62)
VL< 50 (p<0.001 OR 1.58)82,5% 84,0%76,3%
Conclusions• High rates of retention in care and ART are observed in Chile up to 3 years
F up with 95,6% of patients on ART at 1 year of initiation decreasing to 89,6% at 3 years.
• High rates of virological suppression were seen in a cross sectional analysis in 2016 as well, with 90,5% of patients suppressed below 1,000 c/mL and 82,5% fully suppressed.
• Women show lower rates of retention and virological success than men.
• Considering retention and suppression rates, 86,8% of patients remain on ART and virologically suppressed. The third goal of 90-90-90 seems to be attainable in the short time in Chile but important efforts need to be done to test and link people not enrolled in care to timely initiate ART.
Acknowledgements