Determinants of Treatment Access in a Population-Based Cohort of HIV-Positive Men and Women Living in Argentina

Objective: To report emerging data on the use of highly active antiretroviral therapy (HAART)in Argentina by assessing patterns of HAART access and late vs early treatment initiation in apopulation-based cohort of adults infected with HIV type-1.Design: The Prospective Study on the Use and Monitoring of Antiretroviral Therapy (PUMA) is astudy of 883 HIV-positive individuals enrolled in the Argentinean drug treatment program.Individuals were 16 years of age and older and were recruited from 10 clinics across Argentina.Methods: Sociodemographic and clinical characteristics were examined using contingency tables(Pearson chi-square test and Fisher exact test) for categoric variables and Wilcoxon rank-sum testfor continuous variables. To analyze time to initiation of HAART we used Kaplan-Meier methodsand Cox regression.Results: Patients who initiated HAART were more likely to be older, have an AIDS-defining illness,be an injection drug user (IDU), have a lower median CD4 cell count, have a higher median viralload, and be less likely to be men who have sex with men (MSM). In multivariate analysis, AIDSdefiningillness and plasma viral load were significantly associated with time to starting therapy.Patients who received late access were more likely to be diagnosed with AIDS and have highermedian plasma viral loads than those receiving early access.Conclusion: Our results indicate that despite free availability of treatment, monitoring, and carein Argentina, a significant proportion of men and women are accessing HAART late in the courseof HIV disease. Further characterization of the HIV-positive population will allow for a morecomprehensive evaluation of the impact of HAART within the Argentinean drug treatmentprogram.