Based on a systematic review and meta-analysis of 29 studies, researchers from China concluded that treatment deferral after HIV diagnosis is common worldwide, especially among young patients and people with relatively high CD4 counts.
Research
The meta-analysis methodology included studies conducted in 15 countries from 2015 to 2022: 16 studies in Asia, 9 in Africa, 3 in Europe and 1 in North America. A total of 121,142 participants were included. Treatment failure within thirty days of confirmation of HIV diagnosis is called delayed initiation of antiretroviral therapy (ART).
According to the review, 36% of participants refused HIV treatment. Men and younger patients were more likely to refuse treatment after diagnosis. 40% of participants with a CD4 of more than 500 cells refused treatment. This accounted for 25% of patients with a CD4 of less than 200.
Compared to people living in low- or middle-income countries, participants from high-income countries were more likely to start treatment early.
Comments
Researchers noted that the lifelong nature of treatment may prevent young people from starting ART. Alternatively, people with high CD4 counts may feel healthy and not see the need for medication. Counseling and additional support may be helpful in this case. A previous study showed that patients who did not start HIV treatment immediately (CD4 above 500) had twice as many AIDS cases, more health problems, and a higher risk of death. The researchers also noted that further research is needed to identify effective strategies to encourage early ART initiation