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Candevir A, Kuscu F, Kurtaran B, Kömür S, İnal AS, Ertürk D, Taşova Y. Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey. Int J Gen Med 2023; 16:4227-4234. [PMID: 37745135 PMCID: PMC10516126 DOI: 10.2147/ijgm.s424561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
Background Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected. Methods The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as "not late". Results Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004). Conclusion HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.
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Affiliation(s)
| | - Ferit Kuscu
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | | | - Süheyla Kömür
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Ayşe Seza İnal
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Damla Ertürk
- Infectious Diseases, Health Sciences University Izmir Tepecik Education and Research Hospital, İzmir, Türkiye
| | - Yeşim Taşova
- Infectious Diseases, Çukurova University, Adana, Türkiye
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Xu Z, Shen Q, Wang D, Dong Z, Han W, Tian R, Zhou K, Ya X, Hu H. Real-world data in late presentation of HIV infection in Suzhou, China: Results from four consecutive cross-sectional surveys, 2017-2020. Front Public Health 2023; 11:1084840. [PMID: 36895684 PMCID: PMC9989277 DOI: 10.3389/fpubh.2023.1084840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
Objectives This study aimed to examine the real prevalence of late presentation of HIV infection and to identify factors associated with late HIV presentation among patients with newly diagnosed HIV/AIDS in Suzhou, China. Methods Patients with newly diagnosed HIV/AIDS who registered in national AIDS surveillance system from 2017 to 2020 were included in this study. Late presentation (LP) of HIV infection was defined as HIV diagnosis with a CD4 count < 350 cells/μL or an AIDS-defining event. Multivariable logistic regression analyses were used to identify factors associated with LP. Results A total of 2,300 patients were enrolled. 1,325 were classified as late presenters, showing a high percentage of 57.6% (95% CI: 54.5-60.7%) and a rise (P = 0.004) over the four-year period. Patients with newly diagnosed HIV/AIDS who were older than 24 years of age (aOR = 1.549, P = 0.001 for 25-39 years; aOR = 2.389, P < 0.001 for 40 years and older), were Suzhou registered residents (aOR = 1.259, P = 0.026), and were from inpatient and outpatient (aOR = 1.935, P < 0.001) were more likely to be late presentation. Conclusions This study showed a high percentage and a rise of late presentation of HIV infection among patients with newly diagnosed HIV/AIDS in Suzhou, China, which is a challenge for future prevention and control of AIDS. Targeted measures should be urgently implemented to reduce late HIV diagnosis.
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Affiliation(s)
- Zhihui Xu
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Qiang Shen
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Di Wang
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Zefeng Dong
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Weining Han
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Runfang Tian
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Kai Zhou
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Xuerong Ya
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Chappell E, Kohns Vasconcelos M, Goodall RL, Galli L, Goetghebuer T, Noguera‐Julian A, Rodrigues LC, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro ML, Ramos JT, Warszawski J, Spolou V, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb DM, Giaquinto C, Judd A, Collins IJ. Children living with HIV in Europe: do migrants have worse treatment outcomes? HIV Med 2022; 23:186-196. [PMID: 34596323 PMCID: PMC9293243 DOI: 10.1111/hiv.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe. METHODS Children aged < 18 years at the start of antiretroviral therapy (ART) in European paediatric HIV observational cohorts where ≥ 5% of children were migrants (defined as born abroad) were included. Three outcomes were considered: (i) severe immunosuppression-for-age; (ii) viraemic viral load (≥ 400 copies/mL) at 1 year after ART initiation; and (iii) AIDS/death after ART initiation. The effect of migrant status was assessed using univariable and multivariable logistic and Cox models. RESULTS Of 2620 children included across 12 European countries, 56% were migrants. At ART initiation, migrant children were older than domestic-born children (median 6.1 vs. 0.9 years, p < 0.001), with slightly higher proportions being severely immunocompromised (35% vs. 33%) and with active tuberculosis (2% vs. 1%), but a lower proportion with an AIDS diagnosis (14% vs. 19%) (all p < 0.001). At 1 year after beginning ART, a lower proportion of migrant children were viraemic (18% vs. 24%) but there was no difference in multivariable analysis (p = 0.702), and no difference in severe immunosuppression (p = 0.409). However, there was a trend towards higher risk of AIDS/death in migrant children (adjusted hazard ratio = 1.51, 95% confidence interval: 0.96-2.38, p = 0.072). CONCLUSIONS After adjusting for characteristics at ART initiation, migrant children have virological and immunological outcomes at 1 year of ART that are comparable to those who are domestic-born, possibly indicating equity in access to healthcare in Europe. However, there was some evidence of a difference in AIDS-free survival, which warrants further monitoring.
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Affiliation(s)
| | - Malte Kohns Vasconcelos
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Institute for Medical Microbiology and Hospital HygieneHeinrich Heine University DüsseldorfDüsseldorfGermany
- Paediatric Infectious Diseases Research GroupInstitute for Infection and ImmunitySt. George's, University of LondonLondonUK
| | | | - Luisa Galli
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Tessa Goetghebuer
- Department of PediatricsHôpital St PierreUniversité libre de BruxellesBruxellesBelgium
| | - Antoni Noguera‐Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases UnitDepartment of PediatricsSant Joan de Déu Hospital Research FoundationBarcelonaSpain
- Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of PediatricsUniversity of BarcelonaBarcelonaSpain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
| | - Laura C. Rodrigues
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Henriette Scherpbier
- Emma Children's Hospital/Amsterdam University Medical CentreAmsterdamThe Netherlands
| | - Colette Smit
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCLLondonUK
- Great Ormond Street Hospital for Children NHS TrustLondonUK
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Marissa Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
- Hospital General Universitario "Gregorio Marañón"MadridSpain
- Universidad ComplutenseMadridSpain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM)MadridSpain
| | - Jose T. Ramos
- Departamento de Salud Pública y Materno‐infantilUniversidad ComplutenseHospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
| | - Josiane Warszawski
- Service d'Epidémiologie et Santé PubliqueAP‐HPHôpital BicêtreLe Kremlin‐BicêtreFrance
- Unité de Recherche Clinique Paris Descartes Necker CochinAP‐HPParisFrance
| | - Vana Spolou
- First Department of PaediatricsInfectious Diseases Unit, “Agia Sophia” Childrens' HospitalAthensGreece
| | - Elena Chiappini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Elisabetta Venturini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | | | - Christian Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal HospitalInfectious Diseases and Hospital EpidemiologySt GallenSwitzerland
| | | | - Laura Marques
- Centro Hospitalar e Universitário do PortoPortoPortugal
| | - Lars Naver
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Ali Judd
- MRC Clinical Trials Unit at UCLLondonUK
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Miranda MNS, Pingarilho M, Pimentel V, Martins MDRO, Vandamme AM, Bobkova M, Böhm M, Seguin-Devaux C, Paredes R, Rubio R, Zazzi M, Incardona F, Abecasis A. Determinants of HIV-1 Late Presentation in Patients Followed in Europe. Pathogens 2021; 10:pathogens10070835. [PMID: 34357985 PMCID: PMC8308660 DOI: 10.3390/pathogens10070835] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0-41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.
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Affiliation(s)
- Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Correspondence: ; Tel.: +351-213-652-600
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Maria do Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Anne-Mieke Vandamme
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Laboratory Clinical and Epidemiological Virology, Department of Microbiology and Immunology, KU Leuven, Rega Institute for Medical Research, 3000 Leuven, Belgium
| | - Marina Bobkova
- Gamaleya Research Center of Epidemiology and Microbiology, Department of General Virology, Gamaleya Scientific Research Institute, 123098 Moscow, Russia;
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, 66421 Homburg, Germany;
| | - Carole Seguin-Devaux
- Laboratory of Retrovirology, Department of Infection and Immunity, Luxembourg Institute of Health, L-4354 Esch-sur-Alzette, Luxembourg;
| | - Roger Paredes
- Infectious Diseases Department and IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, 28026 Madrid, Spain;
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Francesca Incardona
- IPRO—InformaPRO S.r.l., 98, 00152 Rome, Italy;
- EuResist Network, 98/100, 00152 Rome, Italy
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
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5
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Abgrall S, Raho-Moussa M, Seng R, Ghislain M, Matheron S, Pialoux G, Goujard C, Meyer L. Elevated risk of viral rebound on ART in migrants living in France: role of socioeconomic factors. Antivir Ther 2020; 24:541-552. [PMID: 31868654 DOI: 10.3851/imp3339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Western countries, viral rebound on antiretroviral therapy (ART) appears to occur more frequently in migrants. We aimed to assess the respective roles of socioeconomic factors and migration on viral rebound in people living with HIV (PLHIV) in France. METHODS We included PLHIV in France, enrolled from 2004 to 2008 in the French ANRS-COPANA cohort, who started a first ART and achieved undetectability (<50 copies/ml) within 1 year. Determinants of viral rebound were assessed using Cox models including geographical origin, HIV transmission group, and clinicobiological and sociodemographic data. RESULTS Of 499 included individuals, 288 were born in France, 158 in sub-Saharan Africa (SSA) and 53 in another country. Kaplan-Meier probabilities of viral rebound-free survival were similar for men having sex with men (MSM) and heterosexuals born in France, and lower in migrants from SSA or other countries (P<0.001). The crude hazard ratio (HR) of viral rebound was 2.49 (95% CI, 1.59, 3.90) in migrants from SSA and 1.78 (0.94, 3.88) in migrants from other countries compared with MSM born in France. Educational level, financial difficulties and HIV status disclosure had the biggest impact on the difference between the crude and adjusted HRs for viral rebound in migrants. In multivariable analysis, viral rebound was no longer associated with geographical origin, but with protease inhibitor-containing ART, a VACS index ≥35 as a potential indicator of frailty, poor financial status (difficulties or debts) and non-disclosure to friend(s). CONCLUSIONS Socioeconomic factors affect outcomes on ART, even in the context of free access to HIV care and treatment. Patient-centred strategies should be encouraged with the intervention of social workers to address basic needs and promote social support for more socially vulnerable individuals.
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Affiliation(s)
- Sophie Abgrall
- APHP, Hôpital Béclère, Service de Médecine Interne, Clamart, France.,APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mariem Raho-Moussa
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Rémonie Seng
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mathilde Ghislain
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Sophie Matheron
- APHP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gilles Pialoux
- APHP, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France.,UPMC, Univ Paris 06, Paris, France
| | - Cécile Goujard
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Médecine Interne, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France
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