4CPS-243 Delayed HIV treatment and factors associated

Background and ImportanceClinical practice guidelines (EACS, DHHS, Gesida) recommend starting antiretroviral therapy (ART) as soon as possible after HIV diagnosis, irrespective of CD4 cell count (CD4c). Postponing ART start until complementary assessments depends on the setting, medical indications and risk of loss from care.Aim and ObjectivesTo analyse delay in treatment initiation over the past ten years and to understand factors associated with delayed ART initiation.Material and MethodsRetrospective observational study in patients diagnosed with HIV infection in an integrated health area from January-2012 to June-2022. Variables collected: age, sex, route of infection, healthcare setting of diagnosis, time from diagnosis to ART initiation (delay time), ART, AIDS stage, baseline VL and CD4c.Data were collected from electronic medical records and outpatient dispensation program. Statistical analysis was performed using Student´s t-test and linear regression method (dependent variable: delay time) by SPSS®v.15.0.Results108 patients were included, median age was 34 years (IQR 29.2-42.7) and 76.9% were men. 41.7% were diagnosed in primary care and 58.4% in the hospital setting. 38.9% were in AIDS stage at diagnosis. The predominant route of infection was men who have sex with men (MSM) 50.9%.ART was initiated with nucleoside reverse-transcriptase inhibitors (NRTI) combined with integrase-strand-transfer inhibitors (INSTI) 66.7%, non-nucleoside reverse-transcriptase inhibitors (NNRTI) 13% and boosted protease inhibitors (PI/b) 20.4%.The median baseline logVL was 4.63 (4.13-5.14) and CD4c was 325 (95-500).The median delay was 21 days (IQR 9-55). Factors associated with delay: baseline CD4c (for every 100 CD4 increase the delay time was extended by 2.29 days (95% CI 0.56 to 4.02; p=0.01); baseline logVL (-3.25 days 95% CI 1.57-8.08; p=0.18); AIDS at diagnosis (-5.40 days; 95% CI 3.30-14.10; p=0.2); use of INSTI or PI/b compared to NNRTI (-31.28 days; 95% CI 7.85-54.71; p= 0.016). For each year of evolution, the time to ART initiation was reduced by 3.05 days (95% CI1.59-4.50; p