Systemic global review reports high prevalence of delayed HIV treatment initiation

A large meta-analysis reports that delaying treatment after an HIV diagnosis remains relatively common globally, especially among younger people and those with a relatively high CD4 count. The findings point to the continued need for interventions to promote early antiretroviral therapy (ART) initiation, the study authors state.

About This Study

“Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis” was published online on Oct. 24, 2023, in PLoS One. The lead author is Yan Tao of the Xiangya Nursing School at the Central South University in Changsha, Hunan Province, People’s Republic of China.

Key Research Findings

This meta-analysis of 29 studies conducted among 121,142 people living with HIV in 15 countries between 2015 and 2022 assessed the prevalence of delaying HIV treatment after diagnosis in Asia (16 studies), Africa (nine studies), Europe (three studies), and North America (one study). Only studies published in English or Chinese were included. Delayed ART initiation was defined as not starting treatment within 30 days of a confirmed HIV diagnosis. Sample sizes in different cohorts varied widely, from 244 participants to 34,528 participants per study.

Overall, 36% of participants delayed HIV treatment. Older participants were more likely to start treatment right away, as were women, when compared to younger participants and men, respectively. Forty percent of participants with CD4 cell counts > 500 cells/mm³ delayed ART, compared to 25% of those with CD4 cell counts ≤ 200 cells/mm³. Participants in high-income countries were more likely to start treatment late than those in low- and middle-income countries.

Discussion Highlights and Implications for Practice

Limitations reported included the fact that only English- or Chinese-language studies were included, that most studies were conducted in China and South Africa, and that the included studies were quite heterogeneous.

The researchers commented that for young people, the cost of medications and the life-long nature of treatment may be a barrier to ART initiation. Subsidizing that expense could improve ART coverage in this population. In addition, they said that at high CD4 cell counts, people living with HIV may feel healthy and see no need for medications. Counseling and additional support may overcome such hesitance.

Further research is needed to determine the reasons for the greater prevalence of delayed ART in high-income countries compared to those in low- and middle-income countries, the authors said.

By Barbara Jungwirth