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
Authors: Le Guillou Adrien , Pugliese Pascal , Raffi François , Cabie André , Cuzin Lise , Katlama Christine , Allavena Clotilde , Drame Moustapha , Cotte Laurent , Bani-Sadr Firouzé ,   Dat’AIDS Study Group, Orticoni M , Soavi M J , Luquet- Besson I , Ressiot E , Carta- Padovani M , Ducassou M J , Bertone H , Galie S , Galinier A , Monclar M , Ritleng A S , Ivanova A , Blanco-Betancourt C , Lions C , Poizot-Martin I , Dhiver C , Saadia Mokhtari M , Ménard A , Tissot Dupont H , Toméi C , Meddeb L , Belkhir A Y , Ravaux I , Alvarez M , Biezunski N , Debard A , Delpierre C , Lansalot P , Lelièvre L , Martin-Blondel G , Piffaut M , Porte L , Saune K , Delobel P , Pugliese P , Breaud S , Ceppi C , Chirio D , Cua E , Dellamonica P , Demonchy E , De Monte A , Durant J , Etienne C , Ferrando S , Garraffo R , Michelangeli C , Mondain V , Allavena C , Bernaud C , Billaud E , Biron C , Bonnet B , Bouchez S , Boutoille D , Brunet-Cartier C , Deschanvres C , Gaborit B , Hall N , Jovelin T , Le Turnier P , Morineau P , Reliquet V , Sécher S , Cavellec M , Soria A , Ferré V , André-Garnier E , Rodallec A , Lefebvre M , Grossi O , Aubry O , Raffi F , Amazzough K , Benabdelmoumen G , Bossi P , Cessot G , Charlier C , Consigny P H , Danion F , Dureault A , Duvivier C , Goesch J , Guery R , Henry B , Jidar K , Lanternier F , Loubet P , Lortholary O , Louisin C , Lourenco J , Parize P , Pilmis B , Touam F , Valantin M A , Tubiana R , Agher R , Seang S , Schneider L , PaLich R , Blanc C , Katlama C , Cabié A , Cuzin L , Abel S , Pierre-François S , Pasquier J , Guitteaud K , Turmel J M , Illiaquer M , Fischer P , Partisani M , Cheneau C , Priester M , Batard M L , Bernard-Henry C , de Mautort E , Fafi-Kremer S , Rey D , Chirouze C , Gardiennet Q , Bani-Sadr F , Berger J L , N’Guyen Y , Lambert D , Hentzien M , Lebrun D , Brunet A , Kmiec I , Brodard V , Cotte L , Chidiac C , Ferry T , Ader F , Biron F , Boibieux A , Miailhes P , Perpoint T , Schlienger I , Lippmann J , Braun E , Koffi J , Longuet C , Guéripel V , Augustin-Normand C , Brochier C , Degroodt S , Atoui N , Le Moing V , Makinson A , Meftah N , de Boever C Merle , Montes B , Montoya Ferrer A , Reynes J , André M , Boyer L , Bouillon M P , Delestan M , May T , Hocqueloux L , Prazuck T , Gubavu C , Sève A , Maka A , Boulard C , Thomas G , Cheret A , Goujard C , Quertainmont Y , Teicher E , Lerolle N , Deradji O , Barrail-Tran A , Landman R , Joly V , Rioux C , Lariven S , Gervais A , Lescure F X , Matheron S , Louni F , Godard C , Julia Z , Chansombat M , Rahli D , Mackoumbou-Nkouka C , Charpentier C , Descamps D , Peytavin G , Yazdanpanah Y , Tattevin P , Revest M , Souala F , Baldeyrou M , Patrat-Delon S , Chapplain J M , Benezit F , Dupont M , Poinot M , Maillard A , Pronier C , Lemaitre F , Guennoun C , Poisson-Vanier M , Jovelin T , Sinteff J P , Arvieux C , Botelho-Nevers E , Gagneux-Brunon A , Frésard A , Lucht F , Ajana F , Aïssi E , Alcaraz I , Baclet V , Bocket L , Boucher A , Choisy P , Huleux T , Lafon-Desmurs B , Meybeck A , Pradier M , Robineau O , Viget N , Valette M , Hoen B , Lamaury I , Fabre I , Curlier E , Ouissa R , Schepers K , Herrmann-Storck C , Dournon N , Merrien D , Perré P , Guimard T , Bollangier O , Leautez S , Morrier M 
Published: August 2019

Abstract

Background
In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count.

Methods
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.

Results
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.

Conclusions
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.

Clinical Trials Registration
NCT02898987.