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