{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T21:26:41Z","timestamp":1785101201857,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T00:00:00Z","timestamp":1576713600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K01\u2010AI131895"],"award-info":[{"award-number":["K01\u2010AI131895"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000052","name":"NIH Office of the Director","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In 2013, the World Health Organization (WHO) recommended initiating combination ART (cART) in all adults with HIV and CD4+ lymphocyte counts (CD4) &lt;500\u00a0cells\/mm<jats:sup>3<\/jats:sup>. In 2015, this was updated to recommend cART initiation in all patients with HIV, regardless of CD4 count. Implementation of these guidelines in real\u2010world settings has not been evaluated in Latin America. To assess changes in time to cART initiation during routine care, we estimated trends in time from enrolment in care to cART initiation in HIV\u2010positive adults with high CD4 counts in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) during 2003 to 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All cART\u2010naive individuals \u226518\u00a0years of age from 2003 to 2017 with CD4 \u2265350\u00a0cells\/mm<jats:sup>3<\/jats:sup> and without AIDS at enrolment at five CCASAnet sites (Brazil, Chile, Honduras, Mexico and Peru) were included. Patients without information regarding AIDS\u2010defining events were excluded. We estimated unadjusted median time from enrolment to cART initiation by calendar year using Kaplan\u2010Meier methods and calculated adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for trends in cART initiation using Cox models and restricted cubic splines for continuous variables, accounting for age, sex, CD4 at enrolment, route of HIV transmission and clinic site.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 3171 patients included, 1,650 (52%) had CD4 \u2265500\u00a0cells\/mm<jats:sup>3<\/jats:sup> at enrolment. Median time to cART initiation after 2013 was 6.21\u00a0weeks (interquartile range (IQR): 1.89, 23.21), and 4.71\u00a0weeks (IQR: 1.43, 9.57) after 2015. Among 763 (24%) patients who never initiated cART, 33 (4.3%) were reported as deceased, 481 (63%) were lost to follow\u2010up, and 249 (33%) were administratively censored before initiation. Adjusted probability of cART initiation greatly increased in recent years, in particular after 2013 and 2015 (2013 vs. 2003: HR\u00a0=\u00a07.14; 95% CI: 5.84 to 8.73, and 2015 vs. 2003: HR\u00a0=\u00a012.60; 95% CI: 10.37 to 15.32).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Time to cART initiation decreased substantially, roughly following changes in WHO guidelines in this real\u2010world setting in Latin America. However, a very high proportion of patients never started cART, compromising retention in care and survival, as shown by their higher proportion of LTFU and death, which reinforce the notion that earlier treatment implementation strategies are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25413","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T16:18:42Z","timestamp":1576772322000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Temporal changes in ART initiation in adults with high CD4 counts in Latin America: a cohort study"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2587-1123","authenticated-orcid":false,"given":"Brenda E","family":"Crabtree\u2010Ram\u00edrez","sequence":"first","affiliation":[{"name":"Departamento de Infectolog\u00eda Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n M\u00e9xico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9212-1560","authenticated-orcid":false,"given":"Yanink","family":"Caro\u2010Vega","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n M\u00e9xico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4775-4734","authenticated-orcid":false,"given":"Pablo F","family":"Belaunzar\u00e1n\u2010Zamudio","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n M\u00e9xico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan E","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1951-9104","authenticated-orcid":false,"given":"Peter F","family":"Rebeiro","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdilea","family":"Veloso","sequence":"additional","affiliation":[{"name":"Instituto de Pesquisa Cl\u00ednica Evandro Chagas Fundac\u00e3o Oswaldo Cruz Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia P","family":"Cortes","sequence":"additional","affiliation":[{"name":"Facultad de Medicina de la Universidad de Chile and Fundaci\u00f3n Arriar\u00e1n Santiago de Chile Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Padgett","sequence":"additional","affiliation":[{"name":"Instituto Hondure\u00f1o de Seguro Social and Hospital Escuela Universitario Tegucigalpa Honduras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Gotuzzo","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Tropical Alexander von Humboldt Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Sierra\u2010Madero","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n M\u00e9xico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine C","family":"McGowan","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5663-3243","authenticated-orcid":false,"given":"Anna K","family":"Person","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Caribbean, Central, South America Network for HIV Epidemiology (CCASAnet)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,19]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Scaling Up Antiretroviral Therapy in Resource Limited Settings: Guidelines for a Public Health Approach","author":"World Health Organization WHO","year":"2002"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/586713"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600693"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0807252"},{"key":"e_1_2_9_6_1","first-page":"25","article-title":"Consolidated Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection","volume":"27","author":"World Health Organization WHO","year":"2013","journal-title":"WHO Libr"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506816"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1507198"},{"key":"e_1_2_9_9_1","unstructured":"World Health Organization.Policy Brief: Consolidated guidelines on the use of antiretroviral therapy and preventing HIV infection. What's new.WHO Guidelines;2015."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002357"},{"key":"e_1_2_9_11_1","first-page":"e10022015","article-title":"Initiating antiretroviral therapy for HIV at a patient's first clinic visit: the RapIT randomized controlled trial","volume":"13","author":"Rosen S","year":"2016","journal-title":"PLoS Med"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001134"},{"key":"e_1_2_9_13_1","volume-title":"Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017","author":"World Health Organization WHO","year":"2017"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0020272"},{"key":"e_1_2_9_15_1","unstructured":"Centro Nacional para la Prevenci\u00f3n y Control del VIH y el sida.Informe nacional del monitoreo de compromisos y objetivos ampliados para poner fin al sida (Informe GAM).2018. [cited 2019 Oct 28]; Available from:https:\/\/www.gob.mx\/cms\/uploads\/attachment\/file\/374632\/Informe_GAM_Mex2018.pdf"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-10-4-78"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010490"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181a44f0a"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dym073"},{"key":"e_1_2_9_20_1","unstructured":"Ministerio de Salud. S\u00edndrome de la Inmunodeficiencia adquirida VIH\/SIDA.Gu\u00eda Cl\u00ednica AUGE Minist Salud.2013;6\u2013170. [cited 2019 Oct 28]; Available from:https:\/\/www.minsal.cl\/sites\/default\/files\/files\/GPCVIH.pdf"},{"key":"e_1_2_9_21_1","unstructured":"Ministerio de Salud.Gu\u00eda Cl\u00ednica S\u00edndrome de Inmunodeficiencia Adquirida VIH\/SIDA. Santiago: MINSAL 2010. [cited 2019 Oct 28]; Available from:http:\/\/www.bibliotecaminsal.cl\/wp\/wp-content\/uploads\/2016\/01\/chile_sida-guia.pdf"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002534"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835c12f9"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1818"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60932-4"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001411"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-38"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2013.0208"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.064329"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjia2.25413","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25413","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25413","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T04:55:18Z","timestamp":1694148918000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1002\/jia2.25413"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25413","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"2019-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25413"}}