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Observational Study
. 2025 Mar 4;22(1):29.
doi: 10.1186/s12981-025-00718-8.

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

Thinh Toan Vu  1 , Dhanushi Rupasinghe  2 , Vohith Khol  3 , Romanee Chaiwarith  4 , Junko Tanuma  5 , Nagalingeswaran Kumarasamy  6 , Suwimon Khusuwan  7 , IKetut Agus Somia  8 , Sanjay Pujari  9 , Man Po Lee  10 , Rohidas T Borse  11 , Sasisopin Kiertiburanakul  12 , Evy Yunihastuti  13 , Iskandar Azwa  14 , Jun Yong Choi  15 , Hsin-Pai Chen  16 , Rossana Ditangco  17 , Anchalee Avihingsanon  18 , Yasmin Gani  19 , Jeremy Ross  20 , Awachana Jiamsakul  2 ; IeDEA Asia-Pacific
Affiliations
Observational Study

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

Thinh Toan Vu et al. AIDS Res Ther. .

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.

Keywords: ART initiation; Asia–Pacific; COVID-19; Competing risks; WHO guidelines.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval for the study were obtained from the ethics committees of each participating site, the data management and biostatistical center at the Kirby Institute [The University of New South Wales (UNSW) Human Ethics committee], and the coordinating center at TREAT Asia/amfAR. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a Median CD4 at HIV diagnosis, b Median viral load at HIV diagnosis
Fig. 2
Fig. 2
Time to ART initiation from HIV diagnosis among people living with HIV enrolled in TAHOD-CC
Fig. 3
Fig. 3
Factors associated with time to ART initiation from HIV diagnosis among people living with HIV enrolled in TAHOD-CC
See this image and copyright information in PMC

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