{
  "abstract": "Introduction Using three categories of stages of HIV disease at access to care (advanced, intermediate, early HIV disease), we explored the impact of delayed access on the risk of death at up to 5 years and whether progress in antiretroviral regimens has mitigated this impact.Methods Adults from the French Hospital Database on HIV (ANRS CO4-FHDH) cohort with HIV-1 infection and first access to care during 2002–2021 were included. To study the impact of the stage of HIV disease at first access to care on the risk of death, only participants included from 2002 to 2016 were analysed to allow for at least 5 years of follow-up until 31 December 2021. Fine and Gray competing risk models considering lost to follow-up as a competing event were used adjusting for age, gender, mode of acquisition, region of origin, time between diagnosis and access to care, period of access to care (2002–2013 vs 2014–2016).Results Among the 64 400 people living with HIV included, 18 305 (28.4%) had advanced and 13 042 (20.3%) intermediate HIV disease. The 5-year cumulative incidence of death was estimated as 1.8% (95% CI 1.7% to 1.9%) overall, from 0.9% (0.8% to 1.0%) for those with early HIV disease to 6.0% (5.4% to 6.7%) for those with AIDS. People with AIDS had a much higher risk of death than those with early HIV disease, with a sub-distribution HR (sHR) of 18.4 (95% CI 12.0 to 28.4) in the first 6 months of follow-up, which remained significant at 48–60 months: sHR=2.1 (1.3 to 3.3). The risk of death was higher for the other categories of advanced HIV disease but to a smaller extent. The risk of death was not statistically different depending on the calendar period.Conclusions Delayed access to care remains associated with an elevated risk of death, even after 48 months. There was no significant improvement in the risk of death after 2014 when immediate initiation of combined antiretroviral therapy was recommended and integrase strand transfer inhibitor-based regimens became the preferred first-line.",
  "authors": [
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France"
      ],
      "name": "Valérie Potard"
    },
    {
      "affiliations": [
        "Unité VIH-IST, Service d’Immuno-Hematologie,Hôpital Victor Dupouy, Argenteuil, Hospital Centre Victor Dupouy Argenteuil, Argenteuil, France"
      ],
      "name": "Fabienne Caby"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France"
      ],
      "name": "Malamine Gassama"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France"
      ],
      "name": "Emilie Lanoy"
    },
    {
      "affiliations": [
        "PCCEI, Univ Montpellier, INSERM, EFS, Univ Antilles, Montpellier, France",
        "CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France",
        "CHU de Martinique, Service de maladies infectieuses et tropicales, Montpellier Université d’Excellence, Fort-de-france, France"
      ],
      "name": "Sylvie Abel"
    },
    {
      "affiliations": [
        "Service des Maladies Infectieuses et Immunologie Clinique, CHU de Reims, Reims, France"
      ],
      "name": "Firouzé Bani-Sadr"
    },
    {
      "affiliations": [
        "Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service des Maladies Infectieuses et Tropicales, Lyon, France"
      ],
      "name": "Agathe Becker"
    },
    {
      "affiliations": [
        "Aix-Marseille Université, APHM, Hôpital Sainte Marguerite, Marseille, France"
      ],
      "name": "Sylvie Bregigeon"
    },
    {
      "affiliations": [
        "AP-HP Hôpitaux de Paris, Hôpital Saint-Louis, Services des Maladies Infectieuses et Tropicales, Paris, France"
      ],
      "name": "Blandine Denis"
    },
    {
      "affiliations": [
        "Hôpital Raymond Poincaré, Université Paris-Saclay, Garches, AP-HP, Garches, France"
      ],
      "name": "Pierre de Truchis"
    },
    {
      "affiliations": [
        "Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur",
        "IHU Imagine",
        "Institut Cochin - CNRS 8104 - INSERM U1016, Université Paris Cité",
        "Institut Pasteur, Centre Médical, AP-HP, Paris, France"
      ],
      "name": "Claudine Duvivier"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France"
      ],
      "name": "Christine Katlama"
    },
    {
      "affiliations": [
        "CHU de Guadeloupe, Service de Maladies Infectieuses et Tropicales, Pointe-à-Pitre, France"
      ],
      "name": "Isabelle Lamaury"
    },
    {
      "affiliations": [
        "CHU Toulouse, Hôpital Purpan, Service des Maladies Infectieuses et Tropicales, Toulouse, France"
      ],
      "name": "Guillaume Martin-Blondel"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Saint-Antoine Hospital, AP-HP, Paris, France"
      ],
      "name": "Jean-Luc Meynard"
    },
    {
      "affiliations": [
        "Service des Maladies Infectieuses, Inserm CIC 1432 Université de Bourgogne, CHU Dijon, Dijon, France"
      ],
      "name": "Lionel Piroth"
    },
    {
      "affiliations": [
        "Le Trait d’Union, HIV-Infection Care Center, Strasbourg University Hospital, Strasbourg University Hospitals, Strasbourg, France"
      ],
      "name": "Axel Ursenbach"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, CHU de Tourcoing, Tourcoing, France"
      ],
      "name": "Olivier Robineau"
    },
    {
      "affiliations": [
        "Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Hôpital Pontchaillou, Rennes, France"
      ],
      "name": "Pierre Tattevin"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France"
      ],
      "name": "Dominique Costagliola"
    },
    {
      "affiliations": [
        "Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital St Antoine, Paris, France"
      ],
      "name": "Sophie Grabar"
    }
  ],
  "title": "Association between late access to care and mortality for PWH: insights from the French Hospital Database on HIV (ANRS CO4-FHDH) from 2002 to 2016",
  "uid": "8c333d9c-a08b-588f-a403-f8ad2b0b46dc"
}