Reaching the Second and Third Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/AIDS 90-90-90 Targets Is Accompanied by a Dramatic Reduction in Primary HIV Infection and in Recent HIV Infections in a Large French Nationwide HIV Cohort

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>During the study period, 61 822 patients were followed in the Dat’AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39–33.47) months in 2007 to 0.77 (IQR, 0.37–1.60) months in 2017. A decrease in PHI (−35.1%) and PRHI (−25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8–2014.4) and 2013.1 (95% CI, 2011.3–2014.8), respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trials Registration</jats:title> <jats:p>NCT02898987.</jats:p> </jats:sec>

A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population

“…Although France has demonstrated good linkage and retention in HIV care 39 , PLWH represent an economically and socially vulnerable population and these policies appear to have done little to address disparities in depressive disorder prevalence. In line with the latest UNAIDS Strategy which emphasises more integrated, person-centered care, underlying social inequalities must not be forgotten as we envisage the future of HIV care for PLWH.…”

Timeliness of antiretroviral therapy initiation in the era before universal treatment

“…In 2018, 35% of participants entering HIV care were prescribed ART the same day 14 . Many reports from cohorts, clinic-based or program-based sites have published trends of shorter times to ART initiation in more recent years 13 , 15 – 22 particularly after 2015 when “treat all” policy was introduced by WHO 6 .…”

Monitoring Recently Acquired HIV Infections in Amsterdam, The Netherlands: The Attribution of Test Locations

“…As testing history was not available for everyone, we also compared the RITA classification with a more complete variable but less specific indicator for RHI: CD4 count ≥500 cells/mm 3 ; which is considered the lower limit of the normal range in uninfected individuals. A French study reported similar proportions of RHI (36%) based on CD4 count ≥500 cells/mm 3 (18). It should be noted that CD4 counts vary widely between individuals during disease progression, and may drop to <500 cells/mm 3 during acute infections and can be ≥500 cells/mm 3 up to several years after diagnosis (35), explaining the higher proportion of RHI compared to the RITA classification.…”