{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:58:34Z","timestamp":1781614714323,"version":"3.54.5"},"reference-count":38,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":76,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Italy, the COVID-19 pandemic substantially disrupted access to health care services, including HIV screening, contributing to a decline in new HIV diagnoses and increasing late presentations in the postpandemic years. This study assessed the profile and trends of newly diagnosed people living with HIV (ndPLWH) across the prepandemic, peripandemic and postpandemic periods in two major Italian centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study including adults diagnosed with HIV-1 infection between 2015 and 2023 at two HIV outpatient clinics in Central (Centre A) and Northern Italy (Centre B). According to the year of diagnosis, ndPLWH were categorised into four periods spanning from prepandemic to postpandemic years. We compared the number and clinical characteristics of ndPLWH and assessed virological suppression (VS; HIV-RNA &lt;50 copies\/mL) at 6 months after ART initiation. Predictors of VS were identified using logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1042 ndPLWH were evaluated, including 423 (40.6%) from Centre A and 619 (59.4%) from Centre B. AIDS-defining conditions peaked during the pandemic period (31.6%, 61\/193; p=0.031). The time from diagnosis to antiretroviral therapy (ART) initiation shortened substantially from the prepandemic period to the postpandemic period (p&lt;0.001), and the use of integrase strand transfer inhibitor (INSTI)-based regimens increased significantly across these periods (p&lt;0.001). NdPLWH from Central Italy presented with a generally worse clinical profile, but the median time from HIV diagnosis to ART initiation was significantly shorter in this group (p&lt;0.001). At 6\u2009months, 84.5% of the patients achieved VS, with no interperiod variation (p=0.519); a higher CD4 count (adjusted OR (aOR) 1.143; 95%\u2009CI 1.052 to 1.243; p=0.002) and INSTI-based triple therapy (aOR 2.191; 95%\u2009CI 1.455 to 3.299; p&lt;0.001) remained independently associated with VS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite substantial disruptions in HIV care during the COVID-19 pandemic and an increased proportion of late presenters, virological suppression rates remained high and stable throughout all the study periods, with no differences between the centres. These findings highlight the resilience of HIV care systems in Italy and the importance of maintaining tireless testing pathways amid health care challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004777","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:06Z","timestamp":1781612826000},"page":"e004777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical presentation and effectiveness of antiretroviral therapy in newly diagnosed people living with HIV before, during and after the COVID-19 pandemic"],"prefix":"10.1136","volume":"4","author":[{"given":"Andrea","family":"Carbone","sequence":"first","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-871X","authenticated-orcid":false,"given":"Giorgio","family":"Tiecco","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Iannone","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Logiudice","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi Francesco","family":"Salvo","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Scoppettuolo","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Gerami","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Cesanelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Salvi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Cingolani","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Castelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Di Giambenedetto","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Torti","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart Department of Health care Surveillance and Bioethics, Section of Infectious Diseases, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Quiros-Roldan","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy"},{"name":"Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026061605253132000_4.2.e004777.1","unstructured":"Global HIV & AIDS statistics \u2014 fact sheet | UNAIDS. 2025. Available: https:\/\/www.unaids.org\/en\/resources\/fact-sheet"},{"key":"2026061605253132000_4.2.e004777.2","unstructured":"European centre for disease prevention and control, world health organization . HIV\/AIDS Surveillance in Europe 2022: 2021 Data. SE: European Centre for Disease Prevention and Control, 2022. Available: https:\/\/data.europa.eu\/doi\/10.2900\/818446"},{"key":"2026061605253132000_4.2.e004777.3","doi-asserted-by":"crossref","first-page":"106995","DOI":"10.1016\/j.ijid.2024.106995","article-title":"Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis \u2013 results from the ICONA cohort in Italy, 2009-2022","volume":"142","author":"Mondi","year":"2024","journal-title":"International Journal of Infectious Diseases"},{"key":"2026061605253132000_4.2.e004777.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2010.00857.x"},{"key":"2026061605253132000_4.2.e004777.5","unstructured":"Epicentro . Aggiornamento Delle Nuove Diagnosi Di Infezione Da HIV e Dei Casi Di AIDS in Italia al 31 Dicembre 2023. Roma: Istituto Superiore di Sanit\u00e0 (ISS), 2024. Available: https:\/\/www.epicentro.iss.it\/aids\/pdf\/coa-2024.pdf"},{"key":"2026061605253132000_4.2.e004777.6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3390\/life12030420","article-title":"Convalescent Plasma for Hospitalized COVID-19 Patients: A Single-Center Experience","volume":"12","author":"Franchini","year":"2022","journal-title":"Life"},{"key":"2026061605253132000_4.2.e004777.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-022-00496-7","article-title":"The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review","volume":"20","author":"SeyedAlinaghi","year":"2023","journal-title":"AIDS Res Ther"},{"key":"2026061605253132000_4.2.e004777.8","article-title":"Decrease in new diagnosis of HIV\/AIDS in the two years period 2019-2020: impact of COVID-19 pandemic","volume":"11","author":"Quiros-Roldan","year":"2021","journal-title":"J Public Health Res"},{"key":"2026061605253132000_4.2.e004777.9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/QAI.0000000000003140","article-title":"Isolating the Effect of COVID-19-Related Disruptions on HIV Diagnoses in the United States in 2020","volume":"92","author":"Viguerie","year":"2023","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026061605253132000_4.2.e004777.10","doi-asserted-by":"crossref","first-page":"e1046","DOI":"10.1093\/cid\/ciab951","article-title":"Effects of the Coronavirus Disease 2019 Pandemic on Human Immunodeficiency Virus Services: Findings from 11 Sub-Saharan African Countries","volume":"75","author":"Harris","year":"2022","journal-title":"Clinical Infectious Diseases"},{"key":"2026061605253132000_4.2.e004777.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-025-11665-0","article-title":"Evaluating the impact of the COVID-19 pandemic on viral load and CD4 monitoring for people living with HIV on ART in rural Lesotho","volume":"25","author":"Andom","year":"2025","journal-title":"BMC Infect Dis"},{"key":"2026061605253132000_4.2.e004777.12","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1097\/QAD.0000000000004344","article-title":"Evaluating the impact of COVID-19 on the HIV epidemic among MSM in Australia","volume":"39","author":"Weng","year":"2025","journal-title":"AIDS"},{"key":"2026061605253132000_4.2.e004777.13","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/QAI.0000000000003730","article-title":"HIV Incidence, Migration and Diagnosis Dynamics, France, 2012\u20132023: A Surveillance and Modeling Data Analysis","volume":"100","author":"Kunkel","year":"2025","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026061605253132000_4.2.e004777.14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4103\/ijstd.ijstd_28_25","article-title":"HIV testing and diagnosis in 2021 at the apex tertiary referral hospital of India: Impact of COVID-19 pandemic continued","volume":"46","author":"Maurya","year":"2025","journal-title":"Indian J Sex Transm Dis AIDS"},{"key":"2026061605253132000_4.2.e004777.15","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms13030655","article-title":"Outpatient Testing for HIV in Italy, 2018-2023-Preliminary Data","volume":"13","author":"Galli","year":"2025","journal-title":"Microorganisms"},{"key":"2026061605253132000_4.2.e004777.16","doi-asserted-by":"crossref","first-page":"e309","DOI":"10.1016\/S2468-2667(25)00045-3","article-title":"State of health and inequalities among Italian regions from 2000 to 2021: a systematic analysis based on the Global Burden of Disease Study 2021","volume":"10","author":"Naghavi","year":"2021","journal-title":"Lancet Public Health"},{"key":"2026061605253132000_4.2.e004777.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12963-025-00370-4","article-title":"Regional variations in Italy\u2019s COVID-19 death toll: a descriptive analysis of excess mortality and associated factors from 2020 to 2021","volume":"23","author":"Sanmarchi","year":"2025","journal-title":"Popul Health Metr"},{"key":"2026061605253132000_4.2.e004777.18","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1002\/jmv.26499","article-title":"Growth and decline of the COVID-19 epidemic wave in Italy from March to June 2020","volume":"93","author":"De Flora","year":"2021","journal-title":"J Med Virol"},{"key":"2026061605253132000_4.2.e004777.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0242305","article-title":"Analysis of the SARS-CoV-2 epidemic in Italy: The role of local and interventional factors in the control of the epidemic","volume":"15","author":"Lilleri","year":"2020","journal-title":"PLoS One"},{"key":"2026061605253132000_4.2.e004777.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245656","article-title":"Effect of timing of implementation of containment measures on Covid-19 epidemic. 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Late presenters among persons with a new HIV diagnosis in Italy, 2010-2011","volume":"13","author":"Camoni","year":"2013","journal-title":"BMC Public Health"},{"key":"2026061605253132000_4.2.e004777.30","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.15585\/mmwr.mm7148a1","article-title":"HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021","volume":"71","author":"Hoover","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026061605253132000_4.2.e004777.31","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/10815589241252592","article-title":"Emerging from the shadows: Trends in HIV ambulatory care, viral load testing, and viral suppression in a U.S. HIV cohort, 2019\u20132022: Impact of COVID-19 pandemic","volume":"72","author":"Tedaldi","year":"2024","journal-title":"Journal of Investigative Medicine"},{"key":"2026061605253132000_4.2.e004777.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0300335","article-title":"Effects of the COVID-19 pandemic on HIV service delivery and viral suppression: Findings from the SHARP program in Northern Nigeria","volume":"19","author":"Mugo","year":"2024","journal-title":"PLoS ONE"},{"key":"2026061605253132000_4.2.e004777.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-020-00314-y","article-title":"Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy","volume":"17","author":"Quiros-Roldan","year":"2020","journal-title":"AIDS Res Ther"},{"key":"2026061605253132000_4.2.e004777.34","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002754"},{"key":"2026061605253132000_4.2.e004777.35","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/cid\/ciad219","article-title":"Plasma Human Immunodeficiency Virus 1 RNA and CD4+ T-Cell Counts Are Determinants of Virological Nonsuppression Outcomes With Initial Integrase Inhibitor-Based Regimens: A Prospective RESPOND Cohort Study","volume":"77","author":"\u00c1lvarez","year":"2023","journal-title":"Clinical Infectious Diseases"},{"key":"2026061605253132000_4.2.e004777.36","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000013016","article-title":"Integrase inhibitor-based regimens result in more rapid virologic suppression rates among treatment-na\u00efve human immunodeficiency virus\u2013infected patients compared to non-nucleoside and protease inhibitor\u2013based regimens in a real-world clinical setting","volume":"97","author":"Jacobson","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"2026061605253132000_4.2.e004777.37","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1097\/QAD.0000000000004340","article-title":"Impact of antiretroviral regimens containing integrase inhibitors on achieving viral suppression at ultra-low levels compared to other antiretroviral therapy strategies","volume":"39","author":"Navarro-Soler","year":"2025","journal-title":"AIDS"},{"key":"2026061605253132000_4.2.e004777.38","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1614"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:14Z","timestamp":1781612834000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjph-2025-004777"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004777","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}