Medical and social characteristics of HIV‑positive men with different timings of antiretroviral therapy initiation

The аim: To analyze clinical, laboratory, and socio-demographic characteristics of men with HIV infection at stage 4B depending on the timing of antiretroviral therapy (ART) initiation.
Materials and methods. A retrospective study of 120 men with stage 4B HIV infection undergoing follow-up at the Leningrad Region AIDS Center was conducted in 2024–2025. Clinical, laboratory, and sociodemographic data from primary medical records were assessed and analyzed. Microsoft Excel 2010 and StatTech v. 4.1, the Kruskal–Wallis test, Pearson’s c2 test, and Fisher’s exact test were used for statistical processing and mathematical analysis of the data. The Bonferroni correction was used for multiple pairwise comparisons. Differences were considered statistically significant at p<0.05.
Results and discussion. All patients received antiretroviral therapy (ART); however, most patients had progressive disease, and viral load suppression (<50 copies/mL) was achieved in only 28.3% of cases. Patients were divided into three groups comparable in age and disease stage: Group 1 (n=40; 33.3%) — ART initiated within the first year after diagnosis; Group 2 (n=40; 33.3%) — ART initiation delayed for 1–10 years; Group 3 (n=40; 33.3%) — ART initiated more than 10 years after diagnosis. As the delay before ART initiation increased, the proportion of men living with family decreased from 72.5% in Group 1 to 37.5% in Group 3, as did the proportion of patients with permanent employment (80% and 35%, respectively). At the same time, the proportion of patients with a history of incarceration increased (35%, 45%, and 55%, respectively), as did the prevalence of injectable psychoactive substance use (27.5%, 60%, and 87.5%, respectively). Mean CD4 lymphocyte counts remained low in all groups but were higher in Groups 1 and 2 compared with Group 3 (234.5 cells/mL, 176.4 cells/mL, and 112.6 cells/mL, respectively).
Secondary conditions included pneumocystis pneumonia (PCP), candidal esophagitis, cytomegalovirus (CMV) infection, HIV encephalopathy, cerebral toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy (PML), tuberculosis, mycobacteriosis, and malignant neoplasms. A trend toward an increasing proportion of patients with three secondary conditions from Group 1 to Group 3 was observed (20%, 25%, and 40%, respectively), while the proportion of patients with only one secondary condition decreased (47.5%, 37.5%, and 25%, respectively).
Conclusion. Late initiation of ART is associated with less favorable clinical and social characteristics of patients (low CD4 count, high incidence of secondary diseases, injection drug use, social instability, and history of incarceration). A limitation of the study is its retrospective design, which precludes assessing the causal relationship between the factors studied and disease progression.

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