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Introduction: The relative efficacy of different antiretroviral (ART) regimens has been extensively evaluated in the context of clinical trials, using HIV viral load (VL) measurements at pre-specified timepoints after ART onset. However, data from real-life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different ART regimens on HIV cumulative viraemia over the first 12 months after treatment initiation, using programmatic data from the Ministry of Health of Brazil. Methods: Retrospective cohort study analysing cumulative viraemia under the most frequently used ART regimens in Brazi (tenofovir, lamivudine and dolutegravir (regimen 1); tenofovir, lamivudine and efavirenz (regimen 2); tenofovir, lamivudine and ritonavir-boosted atazanavir (regimen 3)). Results and Discussion: We included 112,243 patients >12 years old who received their first ART prescription between January 2014 and August 2017. Univariate analysis indicated that cumulative viraemia was significantly lower in patients receiving regimen 1 as compared with those receiving regimens 2 or 3 (p Conclusions: Our findings could bring direct benefits to patients as suggested by lower viral replication during treatment, lower risk of HIV transmission, and a potential reduction in resistance mutations in the initial 12 months under ART. Keywords: HIV; antiretroviral treatment; cumulative viremia; efficacy; antiretroviral regimen; real-life, 1 | INTRODUCTION The relative efficacy of different antiretroviral treatment (ART) regimens has been extensively evaluated in the context of clinical trials [1-3]. Nevertheless, real-life studies may still contribute with [...]

Introduction: The impact of specific policies on HIV care has been scarcely investigated. In this study we aimed to analyze the impact of the Treatment For All policy (TFA‐2013) and the adoption of integrase strand transfer inhibitors (INSTIs‐2017) as first‐line therapy on clinical indicators of people living with HIV (PLHIV) in Brazil. Methods: We assessed the public database of Brazil's Ministry of Health and extracted data from 2009 to 2019. We investigated the impact of TFA and INSTIs with a time‐series analysis of four health indicators in PLHIV: antiretroviral treatment (ART) initiation with a CD4+ count >500/mm3; ART initiation <1 month after the first CD4+ measurement; viral load suppression (VLS); and treatment adherence. We explored trends over time by gender, age, macroregion of residency and municipal‐level social vulnerability index. Results: We included 753 316 PLHIV in 2019. Most were males (64.81%) in the 30–49 years age category (50.86%). We observed an overall improvement in all HIV clinical indicators, with notable impact of TFA on timely ART initiation and VLS, and mild impact of INSTIs on treatment adherence. Such improvements were heterogeneous, with remarkable gaps in gender, age and socioeconomic groups that have persisted over time. Indicators point to inferior outcomes among children, older adults, women and people living in socially vulnerable locations. Conclusions: Recent Brazilian public policies have had positive impacts on key HIV clinical indicators. However, our results highlight the need for specific policies to improve HIV care for children, older adults, women and socially vulnerable groups. [ABSTRACT FROM AUTHOR]

Objectives: The coronavirus disease (COVID‐19) pandemic has been associated with severe disruptions in health care services, and nonpharmacological measures such as social distancing also have an impact on access to screening tests and on the long‐term care of patients with chronic conditions globally. We aimed to describe the impact of the COVID‐19 pandemic on HIV testing and treatment and to describe strategies employed to mitigate the impact of COVID‐19 on HIV care. Methods: In this retrospective cohort study, we used secondary data from the AIDS Healthcare Foundation (AHF) Global Quality Program from 44 countries in four continents (Asia, Latin America and the Caribbean, Europe and Africa), and compared information on HIV testing, percentage of positive results, number of in‐person appointments, and number of new enrolments in HIV care from 1 January 2020 to 31 August 2020 with the equivalent period in 2019. Results: Despite marked inter‐country heterogeneities, we found that COVID‐19 was associated with a significant reduction in HIV testing, an increase in the percentage of positive tests, a reduction in the number of in‐person consultations and a reduction in the number of new enrolments in care, despite the implementation of several mitigation strategies. The impact of COVID‐19 differed across continents and key populations. Conclusions: Our findings suggest that, in the years to come, health care services must be prepared to respond to the impact of COVID‐19 on HIV testing and care. Providers and facilities should build on the lessons learned so far to further improve mitigation strategies and establish care priorities for both the pandemic and the post‐pandemic periods. [ABSTRACT FROM AUTHOR]