Research Article Late Onset of Antiretroviral Therapy in Adults Living with HIV in an Urban Area in Brazil: Prevalence and Risk Factors Priscila Ribeiro Guimarães Pacheco , 1 Ana Laura Sene Amâncio Zara, 1 Luiz Carlos Silva e Souza, 1,2 and Mar-lia Dalva Turchi 1,2 1 Federal University of Goias, Institute of Tropical Pathology and Public Health, Brazil 2 Hospital of Tropical Diseases Dr. Anuar Auad, Health Secretary of Goias State, Brazil Correspondence should be addressed to Priscila Ribeiro Guimar˜ aes Pacheco; prprirgp@gmail.com Received 15 January 2019; Revised 4 March 2019; Accepted 21 March 2019; Published 7 April 2019 Academic Editor: Aditya Prasad Dash Copyright © 2019 Priscila Ribeiro Guimar˜ aes Pacheco et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART) leads to improved therapeutic response and reduced HIV transmission. However, a signifcant number of people living with HIV (PLHIV) still start treatment late. Objective. Tis study aimed to analyze characteristics and factors associated with late initiation of ART among HIV-infected treatment-na¨ ıve patients. Methods. Tis cross-sectional study included PLHIV older than 17 years who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System (SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defned as CD4+ cell count < 200 cells/mm 3 or presence of AIDS-defning illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS5, version 21. Te signifcance level was set at p<0.05. Results. 1,141 individuals were included, with a median age of 41 years, and 69.1% were male. Te prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). Te more common opportunistic infections at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. Afer logistic regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion. Tese results revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially vulnerable or have lower self-perceived risk. 1. Introduction Te benefts of highly active antiretroviral therapy (ART) have been widely demonstrated, especially when it comes to reducing morbidity and mortality, improving the quality of life of people living with HIV (PLHIV), and reducing HIV transmission [1, 2]. Prevention of mother-to-child trans- mission of HIV has been very successful around the world and some countries have already eliminated HIV vertical transmission [3]. Despite these major achievements, progress in reducing new sexually or intravenously transmitted HIV infections has been slow in many regions [1]. Te goal of ending the HIV epidemic by 2030, regarded as a public health issue, relies on several aspects, including timely diagnosis, early initiation of ART, high adherence to treatment, and sustained undetectable viral load for the majority of HIV-infected individuals. Te Joint United Nations Program on HIV/AIDS set the 90-90-90 targets to be achieved by 2020, in order to end the HIV epidemic worldwide. Tese targets established that 90% of all people living with HIV should know their diagnosis; 90% of all people with diagnosed HIV infection should be on ART; and 90% of all people receiving ART should achieve viral suppression [4]. Te distinction between early and late treatment of HIV infection is based on CD4+ cell count level and presence of symptoms related to HIV-induced immunosuppression at Hindawi Journal of Tropical Medicine Volume 2019, Article ID 5165313, 8 pages https://doi.org/10.1155/2019/5165313