Virological response and retention in care according to time of starting ART in Italy: data from the Icona Foundation Study cohort
Authors: d’Arminio Monforte Antonella , Tavelli Alessandro , Cozzi-Lepri Alessandro , Castagna Antonella , Passerini Simone , Francisci Daniela , Saracino Annalisa , Maggiolo Franco , Lapadula Giuseppe , Girardi Enrico , Perno Carlo Federico , Antinori Andrea ,   Icona Foundation Study Group, d’Arminio Monforte A , Antinori A , Andreoni M , Castagna A , Castelli F , Cauda R , Di Perri G , Galli M , Iardino R , Ippolito G , Lazzarin A , Marchetti G C , Rezza G , von Schloesser F , Viale P , d’Arminio Monforte A , Antinori A , Castagna A , Ceccherini-Silberstein F , Cozzi-Lepri A , Girardi E , Lo Caputo S , Mussini C , Puoti M , Perno C F , Antinori A , Bai F , Balotta C , Bandera A , Bonora S , Borderi M , Calcagno A , Capetti A , Capobianchi M R , Castagna A , Ceccherini-Silberstein F , Cicalini S , Cingolani A , Cinque P , Cozzi-Lepri A , d’Arminio Monforte A , De Luca A , Di Biagio A , Girardi E , Gianotti N , Gori A , Guaraldi G , Lapadula G , Lichtner M , Lo Caputo S , Madeddu G , Maggiolo F , Marchetti G , Monno L , Mussini C , Nozza S , Perno C F , Pinnetti C , Puoti M , Quiros Roldan E , Rossotti R , Rusconi S , Santoro M M , Saracino A , Sarmati L , Cozzi-Lepri A , Fanti I , Galli L , Lorenzini P , Rodano’ A , Macchia M , Tavelli A , Carletti F , Carrara S , Di Caro A , Graziano S , Petroni F , Prota G , Truffa S , Giacometti A , Costantini A , Barocci V , Angarano G , Monno L , Milano E , Maggiolo F , Suardi C , Viale P , Donati V , Verucchi G , Castelnuovo F , Minardi C , Quiros Roldan E , Menzaghi B , Abeli C , Cacopardo B , Celesia B , Vecchiet J , Falasca K , Pan A , Lorenzotti S , Sighinolfi L , Segala D , Blanc P , Vichi F , Cassola G , Viscoli C , Alessandrini A , Bobbio N , Mazzarello G , Lichtner M , Fondaco L , Bonfanti P , Molteni C , Chiodera A , Milini P , Nunnari G , Pellicanò G , d’Arminio Monforte A , Galli M , Lazzarin A , Rizzardini G , Puoti M , Castagna A , Cannizzo E S , Moioli M C , Piolini R , Bernacchia D , Salpietro S , Tincati C , Mussini C , Puzzolante C , Migliorino C , Lapadula G , Sangiovanni V , Borgia G , Esposito V , Di Flumeri G , Gentile I , Rizzo V , Cattelan A M , Marinello S , Cascio A , Trizzino M , Francisci D , Schiaroli E , Parruti G , Sozio F , Magnani G , Ursitti M A , Andreoni M , Antinori A , Cauda R , Cristaudo A , Vullo V , Acinapura R , Moschese D , Capozzi M , Mondi A , Cingolani A , Rivano Capparuccia M , Iaiani G , Latini A , Gagliardini R , Plazzi M M , De Girolamo G , Vergori A , Cecchetto M , Viviani F , Madeddu G , De Vito A , Rossetti B , Montagnani F , Franco A , Fontana Del Vecchio R , Di Giuli C , Caramello P , Di Perri G , Bonora S , Orofino G C , Sciandra M , Bassetti M , Londero A , Manfrin V , Battagin G , Starnini G , Ialungo A 
Published: December 2019

Abstract

Objectives
To describe: (i) factors associated with rapid and delayed ART initiation; (ii) rates of 12 week virological response; and (iii) virologically controlled retention in care by 1 year from ART initiation according to timing of start in a real-life setting.

Methods
All individuals in the Icona cohort diagnosed with HIV in 2016–17 who initiated ART were grouped according to the time between HIV diagnosis and ART initiation: Group 1, ≤7 days; Group 2, 8–14 days; Group 3, 15–30 days; Group 4, 31–120 days; and Group 5, &gt;120 days. Multivariable logistic regression models were used to identify factors associated with: (i) the probability of rapid (Group 1) and very delayed (Group 5) ART initiation; (ii) the 12 week virological response (by a modified snapshot algorithm); and (iii) the probability of retention in care at 1 year (on ART with HIV-RNA &lt;50 copies/mL).

Results
A total of 1247 individuals were included [82 (6.6%) in Group 1, 115 (9.2%) in Group 2, 267 (21.4%) in Group 3, 641 (51.4%) in Group 4 and 142 (11.4%) in Group 5]. Main predictors of rapid ART start (Group 1) were low CD4 cell count and high HIV-RNA at first contact with the infectious diseases centre. There was no association between probability of virological response and timing of ART initiation. Overall, 90% of individuals remained on ART after 1 year, 91% with undetectable HIV-RNA. Participants of Italian nationality, those with higher CD4 cell count and lower HIV-RNA at ART initiation were more likely to be retained in care after 1 year.

Conclusions
In our high-income observational setting, we did not observe differences in the 1 year rate of virological response and retention in care according to timing of ART initiation.