HIV Infection in Portugal: Measuring the Time Between Linkage to Care and Antiretroviral Therapy Initiation

Background/Objectives: The timely initiation of antiretroviral therapy (ART) in persons living with HIV (PLWH) improves clinical outcomes. However, ART commencement is often delayed. Portugal, which has one of the highest new HIV diagnosis rates within the European Union, has limited available data. Evidence from 2017-2018 suggests that the average time to ART initiation exceeds the recommendations for optimal benefits. This study aimed to assess the number of days from the first hospital appointment to the commencement of ART among newly diagnosed PLWH in Portugal between 2017 and 2022 at the national level and across different hospitals within the country. Methods: A retrospective analysis of records from Portuguese public tertiary care hospitals, which manage the majority of HIV patients, was conducted. Descriptive statistics (measures of central tendency, dispersion, and frequency) were applied, along with association tests and a binary logistic regression model to examine factors influencing the timing of ART initiation. Results: A total of 2,229 cases from 19 hospitals were considered eligible. The median time interval between the first hospital appointment and ART initiation was 29.00 days, with a decreasing tendency between 2017 and 2022. Patients initiating therapy after 14 days had higher CD4 levels and lower viral loads compared to those starting within 14 days, with statistical significance. Conclusions: Continuous and regular monitoring of key indicators, such as the time to ART initiation, is pivotal for assessing the effectiveness of HIV treatment programs and pinpointing areas in need of improvement.