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Fabbiani M, Masini M, Rossetti B, Ciccullo A, Borghi V, Lagi F, Capetti A, Colafigli M, Panza F, Baldin G, Mussini C, Sterrantino G, Farinacci D, Montagnani F, Tumbarello M, Di Giambenedetto S. Efficacy and Durability of Dolutegravir- or Darunavir-Based Regimens in ART-Naïve AIDS- or Late-Presenting HIV-Infected Patients. Viruses 2023; 15:v15051123. [PMID: 37243208 DOI: 10.3390/v15051123] [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: 04/07/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Since limited data are available, we aimed to compare the efficacy and durability of dolutegravir and darunavir in advanced naïve patients. METHODS Retrospective multicenter study including AIDS- or late-presenting (def. CD4 ≤ 200/µL) HIV-infected patients starting dolutegravir or ritonavir/cobicistat-boosted darunavir+2NRTIs. Patients were followed from the date of first-line therapy initiation (baseline, BL) to the discontinuation of darunavir or dolutegravir, or for a maximum of 36 months of follow-up. RESULTS Overall 308 patients (79.2% males, median age 43 years, 40.3% AIDS-presenters, median CD4 66 cells/µL) were enrolled; 181 (58.8%) and 127 (41.2%) were treated with dolutegravir and darunavir, respectively. Incidence of treatment discontinuation (TD), virological failure (VF, defined as a single HIV-RNA > 1000 cp/mL or two consecutive HIV-RNA > 50 cp/mL after 6 months of therapy or after virological suppression had been achieved), treatment failure (the first of TD or VF), and optimal immunological recovery (defined as CD4 ≥ 500/µL + CD4 ≥ 30% + CD4/CD8 ≥ 1) were 21.9, 5.2, 25.6 and 1.4 per 100 person-years of follow-up, respectively, without significant differences between dolutegravir and darunavir (p > 0.05 for all outcomes). However, a higher estimated probability of TD for central nervous system (CNS) toxicity (at 36 months: 11.7% vs. 0%, p = 0.002) was observed for dolutegravir, whereas darunavir showed a higher probability of TD for simplification (at 36 months: 21.3% vs. 5.7%, p = 0.046). CONCLUSIONS Dolutegravir and darunavir showed similar efficacy in AIDS- and late-presenting patients. A higher risk of TD due to CNS toxicity was observed with dolutegravir, and a higher probability of treatment simplification with darunavir.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Melissa Masini
- UOC Malattie Infettive, Azienda USL Toscana Sud Est, PO San Donato, 52100 Arezzo, Italy
| | - Barbara Rossetti
- Division of Infectious Diseases, AUSL Toscana Sud Est, Grosseto Hospital, 58100 Grosseto, Italy
| | - Arturo Ciccullo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vanni Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Filippo Lagi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Amedeo Capetti
- Divisione di Malattie Infettive, Dipartimento di Malattie Infettive, Ospedale Universitario Luigi Sacco, 20157 Milano, Italy
| | - Manuela Colafigli
- Unità di Dermatologia Infettiva e Allergologia, Istituto S. Gallicano IRCCS, 00144 Rome, Italy
| | - Francesca Panza
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Gianmaria Baldin
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristina Mussini
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Damiano Farinacci
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Mario Tumbarello
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Grabar S, Potard V, Piroth L, Abgrall S, Bernard L, Allavena C, Caby F, de Truchis P, Duvivier C, Enel P, Katlama C, Khuong MA, Launay O, Matheron S, Melica G, Melliez H, Meynard JL, Pavie J, Slama L, Bregigeon S, Tattevin P, Capeau J, Costagliola D. Striking differences in weight gain after cART initiation depending on early or advanced presentation: results from the ANRS CO4 FHDH cohort. J Antimicrob Chemother 2023; 78:757-768. [PMID: 36683307 DOI: 10.1093/jac/dkad007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many studies have reported weight gain in ART-naive people living with HIV (PWH) initiating an integrase strand-transfer inhibitor-based regimen. We studied the impact of early or advanced presentation and that of individual drugs in PWH initiating combined ART (cART) between 2012 and 2018. METHODS From the French Hospital Database HIV cohort, we assessed factors associated with a weight gain ≥10%, weight change after cART initiation or BMI increase ≥5 kg/m2 up to 30 months. The analyses were conducted overall, and among PWH with early (primary infection or CD4 >350/mm3 and viral load <100 000 copies/mL, without AIDS) and advanced presentation (AIDS or CD4 <200/mm3, not during primary infection). RESULTS At 30 months, 34.5% (95% CI: 33.5-35.6) of the 12 773 PWH had a weight gain ≥10%, with 20.9% (95% CI: 19.6-22.2) among the 5794 with early presentation and 63.1% (95% CI: 60.9-65.3) among the 3106 with advanced presentation. Weight gain was 2.8 kg (95% CI: 2.0-3.7) for those with early presentation and 9.7 kg (95% CI: 8.4-11.1) for those with advanced presentation. Most weight gain occurred in the first 12 months. Underweight and obese PWH were at significantly higher risk of a BMI increase ≥5 kg/m2 than normal-weight PWH. Results differed within classes and by outcome. Raltegravir and dolutegravir were consistently associated with greater weight gain than the other third agents. Tenofovir alafenamide was also associated with higher weight gain than tenofovir disoproxil or abacavir. CONCLUSIONS After initiating cART, PWH with early presentation exhibited a small weight gain, whereas it was large among those with advanced presentation. The choice of ART should account for the risk of weight gain, especially for PWH who present with advanced disease and/or are obese.
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Affiliation(s)
- Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital St Antoine, F75012, Paris, France
| | - Valérie Potard
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Lionel Piroth
- Infectious Diseases Department, CHU Dijon, and Inserm CIC 1432 Université de Bourgogne, Dijon, France
| | - Sophie Abgrall
- AP-HP, Hôpital Béclère, Service de Médecine Interne, Clamart, and Université Paris-Saclay, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | | | - Clotilde Allavena
- Infectious Diseases Department, INSERM EA1413, CHU de Nantes, Nantes, France
| | - Fabienne Caby
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France.,Unité VIH-IST, Service d'Immuno-Hematologie, Hôpital Victor Dupouy, Argenteuil, France
| | - Pierre de Truchis
- AP-HP Hôpital Raymond Poincaré, Université Paris-Saclay, Garches, France
| | - Claudine Duvivier
- AP-HP, Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France.,IHU Imagine, Paris, France.,Institut Cochin-CNRS 8104-INSERM U1016, Université Paris Cité, Paris, France.,Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Patricia Enel
- Assistance Publique-Hôpitaux de Marseille, Public Health Department, Marseille, and Aix-Marseille University, CEReSS, Health Service Research and Quality of Life Center, Marseille, France
| | - Christine Katlama
- AP-HP, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Odile Launay
- Université Paris-Cité, AP-HP, Hôpital Cochin, INSERM, CIC 1417, Paris, France
| | - Sophie Matheron
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, GHU Paris Nord, AP-HP, Paris, France
| | - Giovanna Melica
- Clinical Immunology and Infectious Diseases Department, Henri Mondor Hospital, Creteil, France
| | - Hugues Melliez
- Médecine Interne, Hôpital Riaumont, 62 800, Liévin, France
| | - Jean-Luc Meynard
- AP-HP, Department of Infectious Diseases, Saint-Antoine Hospital, Paris, France
| | - Juliette Pavie
- Department of Immunology and Infectious Diseases, AP-HP Hôtel-Dieu, Paris, France
| | - Laurence Slama
- Infectious Diseases Unit, Hôtel Dieu Hospital, APHP, Paris, France
| | - Sylvie Bregigeon
- Aix-Marseille Université, APHM, Hôpital Sainte-Marguerite, Marseille, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Rennes, France
| | - Jacqueline Capeau
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), F75012, Paris, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
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Burgos J, Moreno-Fornés S, Reyes-Urueña J, Bruguera A, Martín-Iguacel R, Raventos B, Llibre JM, Imaz A, Peraire J, Orti AJ, Dalmau D, Casabona J, Miró JM, Falcó V, Esteve A, Fanjul F, Falcó V, Knobel H, Mallolas J, Tiraboschi J, Curran A, Burgos J, Revollo B, Gracia M, Gutierrez MDM, Murillas J, Homar F, Fernández-Montero JV, González E, Peraire J, Force L, Leon E, Hortos M, Vilaró I, Orti A, Dalmau D, Jaen À, Lazzari ED, Berrocal L, Rodríguez L, Gargoulas F, Vanrell T, Carlos J, Vilà J, Martínez M, Morell B, Tamayo M, Palacio J, Ambrosioni J, Laguno M, Martínez-Rebollar M, Blanco JL, Garcia F, Torres B, Mora LDL, Inciarte A, Ugarte A, Chivite I, González-Cordon A, Leal L, Jou A, Negredo E, Saumoy M, Silva A, Scévola S, Suanzes P, Alvarez P, Mur I, Jaume MR, García-Gasalla M, Ribas MÀ, Campins AA, Peñaranda M, Martin ML, Haydee H, Calzado S, Cervantes M, Navarro M, Payeras A, Cifuentes C, Villoslada A, Sorní P, Molero M, Abdulghani N, Comella T, Sola R, Vargas M, Viladés C, Martí A, Yeregui E, Rull A, Barrufet P, Arbones L, Chamarro E, Escrig C, Cairó M, Martinez-Lacasa X, Font R, Macorigh L, Hernández J. Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens. J Antimicrob Chemother 2022; 78:108-116. [PMID: 36308326 DOI: 10.1093/jac/dkac361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings. METHODS This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell count < 200 cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50 copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350 cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen. RESULTS We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81 cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44 years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3 years of 3.1% (95% CI 1.8%-4.3%), 4.7% (95% CI 2.2%-7.1%) and 7.6% (95% CI 5.4%-9.7%) (P = 0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3-0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350 cells/mm3significantly earlier. CONCLUSIONS In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.
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Affiliation(s)
- Joaquin Burgos
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Sergio Moreno-Fornés
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreu Bruguera
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
| | - Raquel Martín-Iguacel
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Berta Raventos
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Arkaitz Imaz
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, L'Hospitales de Llobregat, Spain
| | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitaria Pere Virgili (IISPV), Tarragona, Spain
| | | | - David Dalmau
- Hospital Universitari MutuaTerrassa, Terrassa, University of Barcelona (Catalonia), Spain
| | - Jordi Casabona
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain.,Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Miró
- Infectious Diseases Clínic. Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Vicenç Falcó
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Severin S, Delforge M, De Wit S. Epidemiology, comorbidities at diagnosis and outcomes associated with HIV late diagnosis from 2010 to 2019 in a Belgian reference centre: A retrospective study. HIV Med 2022; 23:1184-1194. [PMID: 36356949 DOI: 10.1111/hiv.13440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Our objective was to investigate the demographic factors, comorbidities, and outcomes of patients with a late diagnosis (LD) of HIV in a Belgian HIV reference centre. METHODS All patients with HIV who presented for care between 2010 and 2019 were included. They were excluded if time between diagnosis and presentation or first CD4 count exceeded 6 months or if they had previously received antiretroviral therapy (ART). LD was defined as a CD4 cell count ≤350/mm3 or an AIDS-defining event at diagnosis. Data were retrospectively collected and included data on demographic variables, cardiovascular risk factors, comorbidities at diagnosis, first prescribed ART, and outcomes. Logistic regression was used to determine factors associated with LD. RESULTS Of 1078 patients, 427 (39.6%) were LD. In multivariable analysis, the following factors were associated with LD: non-homosexual transmission route, being born in Sub-Saharan Africa (SSA), and age ≥35 years. Prevalence at diagnosis of malignancies, diabetes, and cardiovascular diseases did not differ between non-LD and LD, whereas renal impairment was more frequent in LD. In univariable analysis, high-density lipoprotein (HDL) cholesterol <40 mg/dL and estimated glomerular filtration rate <60 ml/min were associated with LD; in multivariable analysis, only HDL cholesterol <40 mg/dL was associated. Patients with LD experienced more adverse events leading to a switch in ART, virological failure, and death during follow-up. CONCLUSION LD remains common in our centre, especially in non-homosexual patients and those born in SSA. Although not associated with an important burden of comorbidities at diagnosis, it still results in poorer outcomes, emphasizing the need to expand coverage and access to HIV testing.
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Affiliation(s)
- Simon Severin
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
| | - Marc Delforge
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
| | - Stéphane De Wit
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
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5
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Late presentations among HIV-infected patients. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1120546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review. Sci Rep 2021; 11:24133. [PMID: 34921156 PMCID: PMC8683418 DOI: 10.1038/s41598-021-01885-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male (p < 0.001), being Spanish-born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late-stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign-born populations for CHB, and Spanish nationals for CHC.
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Poncet L, Panjo H, Ringa V, Andro A. Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area. PLoS One 2021; 16:e0255900. [PMID: 34388200 PMCID: PMC8363022 DOI: 10.1371/journal.pone.0255900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Homeless migrant women, facing adverse living conditions and barriers to legal status, are at risk of cervical cancer, HIV infection and may encounter barriers to screening services. We investigate factors associated with each screening in a population of migrant women in France and aim to determine the mean time since last HIV testing according to duration of residence in France. METHODS We use data from the DSAFHIR study (Rights and Health of Migrant Women in Emergency Housing) investigating health and migration experience of homeless migrant women housed in emergency housing hotels in the Paris Metropolitan area in 2017. We computed multivariate logistic regression models to investigate no lifetime cervical cancer screening (CCS) and no lifetime HIV test. We used linear regression models to analyze time since last HIV test. RESULTS We included 469 women. 46% of respondents had no lifetime CCS, 31% had no lifetime HIV test. Both screenings were associated with educational attainment and French proficiency. Compared with duration of residence < 1 year, duration ≥ 7 years was associated with a lower likelihood of no lifetime CCS (adjusted Odd Ratio = 0.17; 95% CI = 0.07-0.39). Compared to women born in North Africa, women born in West (aOR = 0.15; 95% CI = 0.07-0.33) and East Africa (aOR = 0.06; 95% CI = 0.02-0.20) were less likely to have no lifetime HIV test. Time since last HIV test increased for each additional year spent in France (coef = 0.21; 95% CI = 0.09, 0.33). CONCLUSION While access to CCS remains poor for recent migrants, HIV testing is more likely to occur shortly after migration.
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Affiliation(s)
- Lorraine Poncet
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
- French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Virginie Ringa
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Armelle Andro
- French Collaborative Institute on Migration, Paris, France
- Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France
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Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, Leo YS, Chow A. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore) 2021; 100:e26507. [PMID: 34190180 PMCID: PMC8257899 DOI: 10.1097/md.0000000000026507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Vernon Jian Ming Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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9
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Impact of Advanced HIV Disease on Quality of Life and Mortality in the Era of Combined Antiretroviral Treatment. J Clin Med 2021; 10:jcm10040716. [PMID: 33670229 PMCID: PMC7916912 DOI: 10.3390/jcm10040716] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.
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10
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Nduaguba SO, Ford KH, Wilson JP, Lawson KA, Cook RL. Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state. Int J STD AIDS 2020; 32:162-169. [PMID: 33327899 PMCID: PMC7879228 DOI: 10.1177/0956462420947567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.
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Affiliation(s)
- Sabina O Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Kentya H Ford
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - James P Wilson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida College of Medicine, Gainesville, FL, USA
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11
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Chimbetete C, Shamu T, Roelens M, Bote S, Mudzviti T, Keiser O. Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe. PLoS One 2020; 15:e0237904. [PMID: 32853215 PMCID: PMC7451579 DOI: 10.1371/journal.pone.0237904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/05/2020] [Indexed: 12/30/2022] Open
Abstract
Background We report trends in mortality patterns and causes among HIV positive patients, who initiated antiretroviral therapy (ART), at an urban clinic in Harare, Zimbabwe. Methods A retrospective cohort study was conducted in which routinely collected data for patients enrolled and followed up between February 2004 and December 2017 were assessed. Patients follow up was from the day of the treatment initiation until exit by death, transfer out or loss to follow up. Two doctors categorized causes of death (COD) as tuberculosis (TB), communicable AIDS, non-communicable diseases (NCDs), malignancies, others and unknown. We used competing risk survival analysis, first to estimate all-causes and cause-specific mortality rates over time, and then to assess risk factors of different causes of death. Results A total of 4 868 patients were followed up for 27 527 person years (PY). Among the 506 patients who died, COD was unknown for 76 patients (15%) and common COD were TB (n = 71, 14%), Malignancies (n = 54, 10.7%) Meningitis (n = 39, 7.7%) and NCDs (n = 60, 11.9%). 49.4% of the deaths were within the first year of starting ART. Median age at death was 36 years (IQR:19–46). There was a near threefold increase in proportion of deaths due to NCDs and malignancies over the period of follow up. Low baseline CD4 cell count and WHO stages 3 & 4 were significant risk factors for all-cause mortality. Conclusions TB remains the leading cause of death among HIV infected people. Deaths due to NCDs and malignancies increased over time. ART facilities need to incorporate management of NCDs including cancer as part of comprehensive care of PLHIV to reduce mortality.
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Affiliation(s)
- Cleophas Chimbetete
- Newlands Clinic, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Maroussia Roelens
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Petrakis V, Panagopoulos P, Maltsan T, Xanthopoulou AM, Terzi I, Papanas N, Maltezos E, Papazoglou D. Late Presenters of HIV Infection in an HIV Unit of a Tertiary University Hospital in a Rural Region of Greece. AIDS Res Hum Retroviruses 2020; 36:601-605. [PMID: 32295383 DOI: 10.1089/aid.2019.0246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A significant progress has been made over the years in the prognosis and treatment of patients with early diagnosis of HIV infection. However, late presentation of a large number of patients remains a serious public health problem. The aim of our study is to highlight the dimensions of the problem by evaluating the data from the HIV Unit of Alexandroupolis, a rural region with population heterogeneity and a strategic position between West and East, Europe, and Asia. This was a retrospective study, including 107 patients diagnosed with HIV infection in our unit from 2010 to 2018. Late presenters (LP) were defined as patients diagnosed with a CD4 cell count <350/mm3 or an AIDS-defining condition regardless of CD4 cell count. The proportion of patients diagnosed late was 49.5%. The majority were males in the age group 31-40 years (41.5%). Men who had sex with men were 37.8%. Among LP, 34% were at Center for Disease Prevention and Control stage C3. The most common AIDS-defining condition observed was Pneumocystis jirovecii Pneumonia (15.1%), followed by esophageal candidiasis (7.5%) and cryptococcal meningitis (3.8%). In addition, immune reconstitution inflammatory syndrome was documented (3.8%). A high percentage of patients were also coinfected with hepatitis B (22.6%) virus. The notably high percentage of LP in our unit demonstrates that late presentation remains a challenge for public health. Further efforts must be made to ensure an early diagnosis of HIV infection. The early initiation of antiretroviral therapy is vital to reduce viral load to undetectable levels and the risk of HIV transmission.
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Affiliation(s)
- Vasileios Petrakis
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Periklis Panagopoulos
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Tzelal Maltsan
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna-Maria Xanthopoulou
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Irene Terzi
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Maltezos
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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13
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Immune profile at HIV infection diagnosis: Evolution in the French Alps area over the last 20 years. Med Mal Infect 2019; 50:428-432. [PMID: 31757516 DOI: 10.1016/j.medmal.2019.10.014] [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: 12/16/2018] [Revised: 04/04/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Health of HIV-infected people relies on early antiretroviral therapy, i.e. early diagnosis. We aimed to determine whether the characteristics at HIV diagnosis in two French medical centres changed over the last 20 years. PATIENTS AND METHODS All individuals diagnosed with HIV infection in Grenoble University Hospital (N=814) and Annecy Hospital (N=246) between 1997 and 2015 were included. We collected age, country of birth, mode of transmission, CD4T cell count, CD4/CD8 ratio, and HIV viral load. RESULTS Among the 1060 patients (mean age 37.4±11 years, 70.2% of men), 42.5% were men having sex with men (MSM); 65.2% were born in France, and 24.4% were born in Africa. Mean CD4T cell count at diagnosis was 396±288/mm3 and was stable over the study period when considering all patients; when considering the MSM group, a significant increase over time was observed, with a mean increase of 7.3 CD4/mm3 per year (P<0.001). A higher CD4 count at diagnosis was observed after 2005 (400±289 vs 468±271/mm3, P=0.005). The proportion of MSM patients with a CD4 count<200/mm3 at diagnosis was lower after 2005 (14.7% after 2005 and 25.6% before, P=0.028) This was not observed in heterosexual patients (born in Africa or not). CONCLUSION In the MSM population, CD4 count at diagnosis is higher after 2005, suggesting that screening campaigns have become more efficient. This was not observed in other populations, who should be better targeted in future strategies.
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14
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Karaosmanoğlu HK, Mete B, Gündüz A, Aydin ÖA, Sargin F, Sevgi DY, Durdu B, Dökmetaş İ, Tabak F. Late presentation among patients with human immunodeficiency virus infection in Turkey. Cent Eur J Public Health 2019; 27:229-234. [PMID: 31580559 DOI: 10.21101/cejph.a5416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/30/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Late presentation of the patients with human immunodeficiency virus (HIV) infection is associated with less favourable treatment responses, more accelerated clinical progression, and a higher mortality risk. Although HIV prevalence is low in Turkey, it is steadily increasing and the information about late presentation among HIV-positives is limited. We aimed to analyze the status of late presentation among HIV-positive patients in Turkey. METHODS All newly diagnosed HIV/AIDS patients from 2003 to 2016 were enrolled in this study by five dedicated centres in Istanbul, Turkey. Demographic data, CD4+ counts, and HIV RNA were collected from medical records and were transferred to a HIV database system. Late pre- sentation was defined as presentation for care with a CD4 count < 350 cells/mm3 or presentation with an AIDS-defining event, regardless of the CD4 cell count. A medical literature search was done for the analysis of late presentation in Turkey. RESULTS The cohort included 1,673 patients (1,440 males, median age 35 years). Among them, 847 (50.6%) had an early diagnosis, with a CD count of more than 350 cells/mm3. The remaining 826 were late presenters. Among late presenters, 427 (25.5% of all, 51.7% of late presenters) presented with advanced HIV disease. Late presenters were more elderly and less educated. The gender seemed comparable between groups. Late presentation was more likely among married patients. Early presenters were more likely among homosexuals, those diagnosed in screening studies, and in lower HIV-RNA viral load category. There has been a decreasing trend among late presenters in 2011-2016 when compared to 2003-2011 period. CONCLUSION Current data suggest that half of HIV-infected patients present late in Turkey. In our cohort, those presented late were more elderly, less educated, married and had heterosexual intercourse. On admission, late presenters had more HIV-related diseases and were more likely in higher HIV-RNA category. In the cohort, men having sex with men were less likely late presenters. Efforts to reduce the proportion of late presentation are essential for almost every country. The countries should identify the risk factors of late presentation and should improve early diagnosis and presentation for HIV care.
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Affiliation(s)
- Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bilgül Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Alper Gündüz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Altuntaş Aydin
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Dilek Yildiz Sevgi
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bülent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - İlyas Dökmetaş
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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15
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Rao S, Av S, Unnikrishnan B, Madi D, Shetty AK. Correlates of Late Presentation to HIV care in a South Indian Cohort. Am J Trop Med Hyg 2019; 99:1331-1335. [PMID: 30226140 DOI: 10.4269/ajtmh.18-0386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Late presentation to healthcare by HIV infected patients' is common in India despite access to free combination antiretroviral therapy (cART). We assessed risk factors for late presentation among patients with a recent HIV diagnosis in an academic university-based antiretroviral treatment center. This retrospective study included 474 recently diagnosed HIV-infected patients registered for cART between 2012 and 2013. Subjects with CD4+ T-lymphocyte (CD4) count ≤ 350 cells/μL or with an AIDS defining event were defined as late presenters (LP) and patients with CD4 count ≤ 200 cells/μL or with an AIDS defining event were defined as LP with advanced HIV disease (LPAD). Multivariable logistic regression analysis was used to investigate factors associated with late presentation. Of the 474 patients, 356 (75.1%) were LP. Of these, 299 (83.99%) were LPAD and 57 (16.01%) LP were AIDS-free. Median CD4 count among LP was 134 cells/μL (interquartile range 72.25-219). Mean age of LP was 42.50 ± 8.88 years; 256 (71.9%) were males. Increasing age (> 51 years; Adjusted odds ratio [aOR] 4.19; P = 0.014) and rural residence (aOR 3.19; P = < 0.001) were independently associated with late presentation. HIV-positive housewives (aOR 0.34; P = 0.027), HIV-positive individuals with negative partners (aOR 0.48; P = 0.006), and partners with unknown HIV status (aOR 0.43; P = 0.007) were less likely to present late compared with positive partners of people living with HIV/AIDS (PLWHA). Most patients were LP despite free access to cART. Rural population and older PLWHA should be targeted while implementing HIV care. There is a need to strengthen the HIV care cascade by linking PLWHA to cART immediately after diagnosis.
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Affiliation(s)
- Satish Rao
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Satheesh Av
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Deepak Madi
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Avinash K Shetty
- Office of Global Health, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Li F, Juan BK, Wozniak M, Watson SK, Katz AR, Whiticar PM, McCormick T, Qiu YS, Wasserman GM. Trends and Racial Disparities of Late-Stage HIV Diagnosis: Hawaii, 2010-2016. Am J Public Health 2019; 108:S292-S298. [PMID: 30383422 DOI: 10.2105/ajph.2018.304506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine racial/ethnic disparities in Hawaii in stage 3 classification at HIV diagnosis and trends in such disparities from 2010 through 2016. METHODS We analyzed data including patients' demographic information, behavioral risk factors, residential county at HIV diagnosis, and type of facility where HIV was diagnosed. Multivariable logistic regression modeling was used to examine racial/ethnic disparities in late-stage diagnoses after adjustment for known or possible confounders. RESULTS About 30% of HIV diagnoses were classified as late-stage (stage 3) diagnoses, and there were significant racial/ethnic disparities in stage 3 classification at diagnosis. Relative to Whites, the odds of being diagnosed at stage 3 were 3.7 times higher among Native Hawaiians and other Pacific Islanders (NHPIs; odds ratio [OR] = 3.69; 95% confidence interval [CI] = 1.89, 7.22) and more than twice as high among Asians (OR = 2.46; 95% CI = 1.16, 5.20). Older age and being diagnosed in an inpatient setting were associated with stage 3 classification. CONCLUSIONS Targeted preventive services need to be strengthened for Asians and NHPIs in Hawaii.
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Affiliation(s)
- Fenfang Li
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Brandi K Juan
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Michelle Wozniak
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Stuart K Watson
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Alan R Katz
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Peter M Whiticar
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Timothy McCormick
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Yuanshan Sandy Qiu
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Glenn M Wasserman
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
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Li MC, Ko NY, Wang LY. The moderator effect of retention in care on late presentation in HIV-infected patients. AIDS Care 2019; 32:93-97. [PMID: 31291744 DOI: 10.1080/09540121.2019.1640848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The moderator effect of retention in care on late presenters in HIV patients has not been well evaluated. A nationwide cohort study focusing on HIV-infected patients with new engagement in care was conducted by using the Taiwan National Health Insurance Research Database. Retention in care was defined based on the healthcare utilization in the first year after engaging in HIV care. Then, the impact of late presentation, retention in care, and their interaction on the risk of subsequent hospitalizations due to opportunistic infections (OIs-hospitalizations) in the second year were examined. More than half (59.38%) of the total patients (n = 9112) were retained in care in the first year, 8.63% were late presenters, and 110 (1.21%) patients had subsequent hospitalization in the second year. Late presentation and non-retention were independent predictors of OIs-hospitalizations in the second year (OR: 2.58 and OR: 3.27, respectively) and the interaction between them was statistically significant (non-retention in care × late presentation, OR: 3.82). This study showed that retention in care in the first year is a moderator providing a stronger protective effect for late presenters than early presenters. Our findings call for policymakers to develop different strategies for early or late presenters.
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Affiliation(s)
- Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Yi Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Vignier N, Desgrees Du Lou A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydie N, Bouchaud O, Dray Spira R, Chauvin P. Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region. AIDS Care 2019; 31:897-907. [PMID: 30709323 DOI: 10.1080/09540121.2019.1576842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012-2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.
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Affiliation(s)
- Nicolas Vignier
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France.,b Department of Infectious and Tropical Diseases , Groupe hospitalier Sud Ile-de-France , Melun , France
| | | | - Julie Pannetier
- c IRD, INSERM , Université Paris Descartes, CEPED, SAGESUD team , Paris , France
| | | | - Anne Gosselin
- c IRD, INSERM , Université Paris Descartes, CEPED, SAGESUD team , Paris , France
| | - France Lert
- d INSERM , Center for Research in Epidemiology and Population Health (CESP-U 1018) , Villejuif , France
| | - Nathalie Lydie
- e Santé Publique France , French National Agency of Public Health , Saint-Maurice , France
| | - Olivier Bouchaud
- f Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412) , Paris 13 University, Assistance Publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital , Bobigny , France
| | - Rosemary Dray Spira
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France
| | - Pierre Chauvin
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France
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19
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Wilton J, Light L, Gardner S, Rachlis B, Conway T, Cooper C, Cupido P, Kendall CE, Loutfy M, McGee F, Murray J, Lush J, Rachlis A, Wobeser W, Bacon J, Kroch AE, Gilbert M, Rourke SB, Burchell AN. Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999-2013). HIV Med 2018; 20:110-120. [PMID: 30430742 DOI: 10.1111/hiv.12686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Timely HIV diagnosis and presentation to medical care are important for treatment and prevention. Our objective was to measure late diagnosis, delayed presentation and late presentation among individuals in the Ontario HIV Treatment Network Cohort Study (OCS) who were newly diagnosed in Ontario. METHODS The OCS is a multi-site clinical cohort study of people living with HIV in Ontario, Canada. We measured prevalence of late diagnosis [CD4 count < 350 cells/μL or an AIDS-defining condition (ADC) within 3 months of HIV diagnosis], delayed presentation (≥ 3 months from HIV diagnosis to presentation to care), and late presentation (CD4 count < 350 cells/μL or ADC within 3 months of presentation). We identified characteristics associated with these outcomes and explored their overlap. RESULTS A total of 1819 OCS participants were newly diagnosed in Ontario from 1999 to 2013. Late diagnosis (53.0%) and presentation (54.0%) were common, and a quarter (23.1%) of participants were delayed presenters. In multivariable models, the participants of delayed presentation decreased over calendar time, but that of late diagnosis/presentation did not. Late diagnosis contributed to the majority (> 87%) of late presentation, and the prevalence of delayed presentation was similar among those diagnosed late versus early (13.4 versus 13.4%, respectively; P = 0.99). Characteristics associated with higher odds of late diagnosis/presentation in multivariable analyses included older age at diagnosis/presentation; African, Caribbean and Black race/ethnicity; Indigenous race/ethnicity; female sex; and being a male who did not report sex with men. There were lower odds of late diagnosis/presentation among participants who had ever injected drugs. In contrast, delayed presentation risk factors included younger age at diagnosis and having ever injected drugs. CONCLUSIONS Late presentation is common in Ontario, as it is in other high-income countries. Our findings suggest that efforts to reduce late presentation should focus on facilitating earlier diagnosis for the populations identified in this analysis.
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Affiliation(s)
- J Wilton
- Ontario HIV Treatment Network, Toronto, Canada
| | - L Light
- Ontario HIV Treatment Network, Toronto, Canada
| | - S Gardner
- Baycrest Health Sciences, Toronto, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - B Rachlis
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - T Conway
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Canadian Positive People Network, Ottawa, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - P Cupido
- Ontario HIV Treatment Network, Toronto, Canada
| | - C E Kendall
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - M Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - F McGee
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Murray
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Lush
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - A Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Science Centre, Toronto, Canada
| | - W Wobeser
- Department of Molecular and Biomedical Sciences, Queen's University, Kingston, Canada.,Department of Public Health, Queen's University, Kingston, Canada
| | - J Bacon
- Ontario HIV Treatment Network, Toronto, Canada
| | - A E Kroch
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - S B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - A N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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20
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Influence of geographic origin on AIDS and serious non-AIDS morbidity/mortality during cART among heterosexual HIV-infected men and women in France. PLoS One 2018; 13:e0205385. [PMID: 30379870 PMCID: PMC6209163 DOI: 10.1371/journal.pone.0205385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/25/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The influence of geographic origin on the risk of severe illness and death on cART has not been explored in European countries. METHOD We studied antiretroviral-naïve heterosexual HIV-1-infected individuals enrolled in the FHDH-ANRS CO4 cohort in France who started cART between 2006 and 2011. Individuals originating from France (French natives), sub-Saharan Africa (SSA) and non-French West-Indies (NFW) were studied until 2012. Crude and adjusted rate ratios (aRR) of severe morbid events/deaths (AIDS-related and non-AIDS-related) were calculated using Poisson regression models stratified by sex, comparing each group of migrants to French natives. RESULTS Among 2334 eligible men, 1379 (59.1%) originated from France, 838 (35.9%) from SSA and 117 (5.0%) from NFW. SSA male migrants had a higher aRR for non-AIDS infections, particularly bacterial infections (aRR 1.56 (95% CI 1.07-2.29), p = 0.0477), than French natives. Among 2596 eligible women, 1347 (51.9%) originated from France, 1131 (43.6%) from SSA, and 118 (4.5%) from NFW. SSA and NFW female migrants had a higher aRR for non-AIDS infections, particularly non-bacterial infections (respectively, 2.04 (1.18-3.53) and 7.87 (2.54-24.4), p = 0.0010), than French natives. We observed no other significant differences related to geographic origin as concerns the aRRs for AIDS-related infections or malignancies, or for other non-AIDS events/deaths such as cardiovascular disease, neurological/psychiatric disorders, non-AIDS malignancies and iatrogenic disorders, in either gender. CONCLUSION Heterosexual migrants from SSA or NFW living in France have a higher risk of non-AIDS-defining infections than their French native counterparts. Special efforts are needed to prevent infectious diseases among HIV-infected migrants.
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21
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Osler M, Hilderbrand K, Goemaere E, Ford N, Smith M, Meintjes G, Kruger J, Govender NP, Boulle A. The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa. Clin Infect Dis 2018; 66:S118-S125. [PMID: 29514233 PMCID: PMC5850025 DOI: 10.1093/cid/cix1140] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Antiretroviral treatment (ART) has been massively scaled up to decrease human immunodeficiency virus (HIV)-related morbidity, mortality, and HIV transmission. However, despite documented increases in ART coverage, morbidity and mortality have remained substantial. This study describes trends in the numbers and characteristics of patients with very advanced HIV disease in the Western Cape, South Africa. Methods Annual cross-sectional snapshots of CD4 distributions were described over 10 years, derived from a province-wide cohort of all HIV patients receiving CD4 cell count testing in the public sector. Patients with a first CD4 count <50 cells/µL in each year were characterized with respect to prior CD4 and viral load testing, ART access, and retention in ART care. Results Patients attending HIV care for the first time initially constituted the largest group of those with CD4 count <50 cells/µL, dropping proportionally over the decade from 60.9% to 26.7%. By contrast, the proportion who were ART experienced increased from 14.3% to 56.7%. In patients with CD4 counts <50 cells/µL in 2016, 51.8% were ART experienced, of whom 76% could be confirmed to be off ART or had recent viremia. More than half who were ART experienced with a CD4 count <50 cells/µL in 2016 were men, compared to approximately one-third of all patients on ART in the same year. Conclusions Ongoing HIV-associated morbidity now results largely from treatment-experienced patients not being in continuous care or not being fully virologically suppressed. Innovative interventions to retain ART patients in effective care are an essential priority for the ongoing HIV response.
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Affiliation(s)
- Meg Osler
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
| | - Katherine Hilderbrand
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Eric Goemaere
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Nathan Ford
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- HIV Department, World Health Organization, Geneva
| | - Mariette Smith
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Department of Health, Provincial Government of the Western Cape
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town
- Department of Medicine, University of Cape Town and Groote Schuur Hospital
| | - James Kruger
- Department of Health, Provincial Government of the Western Cape
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Boulle
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Department of Health, Provincial Government of the Western Cape
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town
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Mehraj V, Cox J, Lebouché B, Costiniuk C, Cao W, Li T, Ponte R, Thomas R, Szabo J, Baril J, Trottier B, Côté P, LeBlanc R, Bruneau J, Tremblay C, Routy J. Socio-economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015. J Int AIDS Soc 2018; 21:e25034. [PMID: 29412520 PMCID: PMC5804015 DOI: 10.1002/jia2.25034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Guidelines regarding antiretroviral therapy (ART) initiation in HIV infection have varied over time, with the 2015 World Health Organization recommendation suggesting ART initiation at the time of diagnosis regardless of CD4 T-cell counts. Herein, we investigated the influence of socio-demographic and clinical factors in addition to time trends on early ART initiation among participants of the Montreal Primary HIV Infection Study. METHODS The Montreal Primary HIV Infection Study is a prospective cohort established in three community medical centres (CMCs) and two university medical centres (UMCs). Recently diagnosed HIV-infected adults were categorized as receiving early (vs. delayed) ART if ART was initiated within 180 days of the baseline visit. Associations between early ART initiation and socio-demographic, socio-economic and behavioural information were examined. Independent associations of factors linked with early ART initiation were determined using multivariable binary logistic regression analysis. RESULTS A total of 348 participants had a documented date of HIV acquisition of <180 days. The median interquartile range (IQR) age of participants was 35 (28; 42) years and the majority were male (96%), having paid employment (63%), men who have sex with men (MSM) (78%) and one to four sexual partners in the last three months (70%). Participants presented with a median IQR HIV plasma viral load of 4.6 (3.7; 5.3) log10 copies/ml, CD4 count of 510 (387; 660) cells/μl and were recruited in CMCs (52%) or UMCs (48%). Early ART initiation was observed in 47% of the participants and the trend followed a V-shaped curve with peaks in 1996 to 1997 (89%) and 2013 to 2015 (88%) with a dip in 2007 to 2009 (22%). Multivariable analyses showed that having a paid employment adjusted odds ratio (aOR: 2.43; 95% CI: 1.19, 4.95), lower CD4 count (aOR per 50 cell increase: 0.93; 95% CI: 0.87, 0.99) and care at UMCs (aOR: 2.03; 95% CI: 1.06 to 3.90) were independently associated with early ART initiation. CONCLUSIONS Early ART initiation during primary HIV infection was associated with diminished biological prognostic factors and calendar time mirroring evolution of treatment guidelines. In addition, socio-economic factors such as having a paid employment, contribute to early ART initiation in the context of universal access to care in Canada.
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Affiliation(s)
- Vikram Mehraj
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Joseph Cox
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Bertrand Lebouché
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Family MedicineMcGill UniversityMontrealQCCanada
| | - Cecilia Costiniuk
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Wei Cao
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Infectious DiseasesPeking Union Medical College HospitalBeijingChina
| | - Taisheng Li
- Department of Infectious DiseasesPeking Union Medical College HospitalBeijingChina
| | - Rosalie Ponte
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | | | - Jason Szabo
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Clinique Médicale l'ActuelMontréalQCCanada
| | | | | | - Pierre Côté
- Clinique Médicale Quartier LatinMontréalQCCanada
| | | | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de MontréalMontréalQCCanada
| | - Cécile Tremblay
- Centre de recherche du Centre Hospitalier de l'Université de MontréalMontréalQCCanada
- Département de microbiologie infectiologie et immunologieUniversité de MontréalMontréalQCCanada
| | - Jean‐Pierre Routy
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Division of HematologyMcGill University Health CentreMontrealQCCanada
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23
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Limousi F, Lert F, Desgrées du Loû A, Dray-Spira R, Lydié N. Dynamic of HIV-testing after arrival in France for migrants from sub-Saharan Africa: The role of both health and social care systems. PLoS One 2017; 12:e0188751. [PMID: 29267347 PMCID: PMC5739385 DOI: 10.1371/journal.pone.0188751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022] Open
Abstract
Objective HIV testing is an important tool in the management of the HIV epidemic among key populations. We aimed to explore the dynamic of first-time HIV testing in France for sub-Saharan migrants after their arrival. Methods ANRS-Parcours is a retrospective life-event survey conducted from 2012 to 2013 in healthcare facilities in the Paris region, among 926 sub-Saharan HIV-infected migrants and 763 non-infected migrants. After describing the time to first HIV test in France and associated circumstances, we performed a discrete-time logistic regression to analyze the influence of socioeconomic position, contact with the healthcare system and sexual behaviors, on first-time HIV testing in France in migrants who arrived after 2000. Results Median first-time HIV testing occurred during the second year spent in France for non-infected men and women in both groups, and during the first year for men of the HIV group. The probability of testing increased with hospitalization and pregnancy for women of both groups. For non-infected men unemployment and absence of a residence permit were associated with an increased probability of HIV testing [respectively, OR = 2.2 (1.2–4.1) and OR = 2.0 (1.1–3.5)]. Unemployment was also associated with an increased probability of first-time HIV-testing for women of the HIV group [OR: 1.7 (1.0–2.7)]. Occasional and multiple sexual relationships were associated with an increased probability of first-time testing only for HIV-infected women [OR: 2.2 (1.2–4.0) and OR = 2.4 (1.3–4.6)]. Conclusion Access to first HIV testing in France is promoted by contact with the health care system and is facilitated for unemployed and undocumented migrants after arrival.However, testing should be offered more systematically and repeated in order to reduce time between HIV infection and diagnosis, especially for deprived people which are particularly vulnerable regarding HIV infection.
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Affiliation(s)
| | - France Lert
- Institut National de la Santé et de la Recherche Médicale (INSERM), CESP-U 1018, Villejuif, France
| | - Annabel Desgrées du Loû
- CEPED, UMR Institut de Recherche pour le développement (IRD)-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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24
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Hansen JF, Hallager S, Øvrehus A, Weis N, Brehm Christensen P, Pedersen C. Late Presentation for Care Among Patients With Chronic Hepatitis C: Prevalence and Risk Factors. Open Forum Infect Dis 2017; 5:ofx257. [PMID: 29367939 PMCID: PMC5774505 DOI: 10.1093/ofid/ofx257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/21/2017] [Indexed: 01/22/2023] Open
Abstract
Patients with chronic hepatitis C may have advanced fibrosis at first evaluation. Using the European Association for the Study of the Liver (EASL) definition (FibroScan® >9.5 kPa) for “late presenter for care” (LP), we found that 32% (169 of 527) of patients were LP. Being a LP was associated with increasing age and a history of alcohol overuse.
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Affiliation(s)
- Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Sofie Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
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25
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Leblanc J, Hejblum G, Costagliola D, Durand-Zaleski I, Lert F, de Truchis P, Verbeke G, Rousseau A, Piquet H, Simon F, Pateron D, Simon T, Crémieux AC. Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Ann Emerg Med 2017; 72:41-53.e9. [PMID: 29092761 DOI: 10.1016/j.annemergmed.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. METHODS In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. RESULTS During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. CONCLUSION The combined strategy of targeted screening and diagnostic testing was effective.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, URC Eco Île-de-France, Paris, France, and Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Santé publique, Créteil, France
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Villejuif, France
| | - Pierre de Truchis
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Infectious Diseases Department, Garches, France
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, and UHasselt, Hasselt, Belgium
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris, Paris, France
| | - Hélène Piquet
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - François Simon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Louis, Microbiology Department, INSERM U941, Paris, France
| | - Dominique Pateron
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, and Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, Paris, France
| | - Anne-Claude Crémieux
- Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Infectious Diseases Department, Université Paris Diderot, Univ Paris 07, Paris, France
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26
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Abstract
PURPOSE OF REVIEW The purpose is to describe and understand the sociodemographic determinants of survival in people living with HIV within high-income countries in the context of the current recommendation of universal antiretroviral therapy for all HIV-infected persons, irrespective of their CD4 cell count. RECENT FINDINGS Survival rates in people living with HIV have experienced remarkable increases in the last decade because of more efficacious and well tolerated treatments. Still, these improvements are unevenly distributed between regions across the world as well as within regions. HIV outcomes are heavily influenced by what are known as the 'social determinants' of health which have traditionally encompassed the gender, race/ethnicity, and socioeconomic axes. The evidence that these social determinants are now more important than before (more and earlier interventions are now available), has become stronger in the last 2 years. SUMMARY Because antiretroviral therapy is now recommended for all HIV-infected persons, sociodemographic factors limiting access to testing, treatment, and retention in care will undoubtedly jeopardize the UNAIDS aspirational objective to end AIDS by 2030. Innovative interventions targeting individuals with social vulnerability are urgently needed to ensure that social inequalities do not continue to be linked with higher mortality.
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Vanobberghen F, Letang E, Gamell A, Mnzava DK, Faini D, Luwanda LB, Mapesi H, Mwamelo K, Sikalengo G, Tanner M, Hatz C, Furrer H, Battegay M, Glass TR. A decade of HIV care in rural Tanzania: Trends in clinical outcomes and impact of clinic optimisation in an open, prospective cohort. PLoS One 2017; 12:e0180983. [PMID: 28719610 PMCID: PMC5515476 DOI: 10.1371/journal.pone.0180983] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/24/2017] [Indexed: 01/18/2023] Open
Abstract
Objectives Our objectives were to describe trends in enrolment and clinical outcomes in the open, prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in the Morogoro region of southern Tanzania, and identify strengths and areas for improvement in the care of HIV-positive individuals in rural Tanzania. Methods We included adults (≥15 years) and children (<15 years) enrolled in the cohort in 2005–2014. The cohort underwent significant changes from autumn 2012 to optimise care. We evaluated mortality and loss to follow-up (LTFU) using competing risks methods, ART usage, opportunistic infections (OI), co-infections and laboratory abnormalities. Results Overall, 7010 adults and 680 children were enrolled; enrolment peaked in 2008 but has increased steadily since 2011. Among adults (65% female; median age 37 [interquartile range 31–45] years), the proportion referred from hospital wards quadrupled in 2013–14 versus earlier years. 653 (9%) adults died and 2648 (38%) were LTFU; the five-year cumulative probabilities of death and LTFU were 10.3% and 44.0%, respectively. Among children, 69 (10%) died and 225 (33%) were LTFU. The corresponding five-year probabilities were 12.1% and 39.6%. Adult ART use (regardless of eligibility) increased from 5% in 2005 to 89% in 2014 (similarly among children), with 9% on second-line therapy in 2014 (17% of children). OI diagnoses increased over time; tuberculosis prevalence at enrolment quadrupled from 6% in 2011 to 26% in 2014. The proportion of newly-enrolled participants assessed for laboratory abnormalities peaked at nearly 100% in 2014 (from a minimum of 24%), yet abnormality prevalences remained fairly constant. Conclusions In this cohort, ART usage improved dramatically and is approaching targets of 90%. Improved screening led to increases in detection of OIs and laboratory abnormalities, suggesting that a large number of these co-morbidities previously went undetected and untreated. Further work will address the high LTFU rates and implications for mortality estimates, and the management and outcomes of co-morbidities.
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Affiliation(s)
- Fiona Vanobberghen
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Emilio Letang
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Anna Gamell
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | | | | | | | | | | | | | - Marcel Tanner
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christoph Hatz
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Bern University Hospital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Tracy R. Glass
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina. PLoS One 2017; 12:e0180361. [PMID: 28672037 PMCID: PMC5495397 DOI: 10.1371/journal.pone.0180361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/14/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to explore the acceptability of rapid HIV self-testing (RHST) among men who have sex with men (MSM). METHODS During 2006-2009, a sample of 500 MSM was recruited through Respondent Driven Sampling for an HIV prevalence/incidence study. Attitude toward RHST was explored among HIV negative MSM. Data were weighted prior to analyses. RESULTS Participants reported they were likely to buy RHST (74%), test themselves more frequently than they currently do (77%), and that the procedure would simplify testing (70%). Furthermore, 71% reported they would probably use it alone, 66% would use it with a steady partner, and 56% with a friend/partner. While a majority acknowledged that RHST use would deprive them of receiving counseling (61%), 74% declared they would go for help if they tested positive; 57% would use an RHST in order to avoid condoms. Probability of use surpassed 70% among gay and non-gay identified MSM as well as those with and without a previous HIV test. Those likely to buy RHST were older (p = 0.025) and more likely to identify as gay (p = 0.036). A total of 17% said they would think about killing themselves and 9% would attempt suicide if they tested positive. These MSM were more likely to be younger (p<0.001), with lower mood level (p<0.001) and greater feelings of loneliness (p = 0.026). CONCLUSIONS The high acceptability of RHST found among MSM should encourage the authorities to consider the possibility of offering it for self-testing, as it can improve early diagnosis and prevention of future transmissions. However, further research is needed to understand how to best disseminate RHST among MSM who wish to use it and to offer support and linkage to care for those who test HIV-positive.
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Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis. J Acquir Immune Defic Syndr 2017; 73:213-21. [PMID: 27632146 DOI: 10.1097/qai.0000000000001043] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. METHODS We conduct ecological analyses (ZIP code, N = 166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/μL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. RESULTS Overall, low to high political participation and social cohesion corresponded with significant (P < 0.0001) decreasing trends in late HIV diagnosis rates. Among men [relative risk (RR) = 0.66, 95% CI: (0.47 to 0.98)] and women [RR = 0.43, 95% CI: (0.28 to 0.67)], highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control [RR = 0.67, 95% CI: (0.48 to 0.93)] among men only and moderate social cohesion [RR = 0.71, 95% CI: (0.55 to 0.92)] among women only were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. DISCUSSION The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.
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Ransome Y, Kawachi I, Dean LT. Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement. AIDS Behav 2017; 21:891-904. [PMID: 27752875 PMCID: PMC5306234 DOI: 10.1007/s10461-016-1581-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007-2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = -1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = -0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Taborelli M, Virdone S, Camoni L, Regine V, Zucchetto A, Frova L, Grande E, Boros S, Dal Maso L, De Paoli P, Serraino D, Suligoi B. The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999-2013. Public Health 2016; 142:39-45. [PMID: 28057195 DOI: 10.1016/j.puhe.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy. STUDY DESIGN We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013. METHODS Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time. RESULTS Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5). CONCLUSIONS The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy.
| | - S Virdone
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - V Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Frova
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - E Grande
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - S Boros
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - L Dal Maso
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - P De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - B Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
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Impact of a primary care national policy on HIV screening in France: a longitudinal analysis between 2006 and 2013. Br J Gen Pract 2016; 66:e920-e929. [PMID: 27672140 DOI: 10.3399/bjgp16x687529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/09/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Early diagnosis of HIV infection is a major public health issue worldwide. In 2009, the French National Authority for Health (Haute Autorité de Santé) developed specific guidelines and recommended mass screening of 15-70-year-olds across the general population. The guidelines were supported by communication directed at healthcare professionals, especially GPs. AIM To assess the impact of the national mass screening policy on HIV testing. DESIGN AND SETTING The study used data from the French National Health Insurance Fund database, from January 2006 to December 2013. Males and females aged 15-70 years, excluding HIV-positive individuals and pregnant females, were followed up throughout the 2006-2013 period. During the study period, 2 176 657 person-years and a total of 329 748 different individuals were followed up. METHOD Standardised and non-standardised rates of HIV screening were calculated for each year; the impact of the policy was assessed using adjusted segmented regression analyses. RESULTS Overall, annual HIV screening rates increased over the study period, from 4.2% (95% confidence interval [CI] = 4.2 to 4.3) in 2006 to 5.8% (95% CI = 5.7 to 5.9) in 2013 with a more pronounced trend after 2010 (P<0.0001). This increase was more significant for those who regularly consulted a GP. For these individuals, the policy led to a 20.4% increase (95% CI = 17.0 to 23.8) in HIV screening in 2013 compared with only a 4.5% increase (95% CI = 4.4 to 4.5) for those who did not consult a GP regularly in 2013. CONCLUSION The results show that the mass screening policy coordinated by GPs had a significant impact on HIV testing in France, which could result in positive impacts on public and individual health outcomes.
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Waldrop G, Doherty M, Vitoria M, Ford N. Stable patients and patients with advanced disease: consensus definitions to support sustained scale up of antiretroviral therapy. Trop Med Int Health 2016; 21:1124-30. [PMID: 27371814 DOI: 10.1111/tmi.12746] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE As guidelines are evolving towards recommending starting antiretroviral therapy (ART) in all HIV-positive individuals irrespective of clinical and immunological status, HIV programmes will be challenged to manage an increasingly diverse set of patient needs. To support global guideline recommendations for differentiated service delivery, WHO developed consensus definitions for two distinct patient populations: patients presenting with advanced disease and patients who are stable on ART. METHODS An expert panel consisting of 73 respondents from 28 countries across all six WHO regions supported the development of these definitions. The panel included clinicians, researchers, programme managers, technical advisors and patient group representatives. RESULTS Patients presenting with advanced disease at presentation to care were defined as CD4 count <200 CD4 cells/mm(3) or WHO Stage III & IV defining illness. Patients stable on ART were defined as those who were receiving ART for at least 1 year with no adverse drug reactions requiring regular monitoring, no current illnesses or pregnancy, a good understanding of lifelong adherence, and evidence of treatment success. Treatment success was defined as two consecutive undetectable viral load measures or, in the absence of viral load monitoring, rising CD4 counts or CD4 counts above 200 cells/mm(3) and an objective adherence measure. CONCLUSIONS Patients who are stable on ART should be offered a less intensive care package that can lead to improved outcomes while saving resources, including less frequent clinic visits, out-of-clinic drug refills and reduced laboratory monitoring. This will allow for clinic resources to be directed towards reducing morbidity and mortality among patients presenting with advanced disease.
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Affiliation(s)
- Greer Waldrop
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
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Slama L, Landman R, Assoumou L, Benalycherif A, Samri A, Joly V, Pialoux G, Valin N, Cabié A, Duvivier C, Lambert-Niclot S, Marcelin AG, Peytavin G, Costagliola D, Girard PM. Efficacy and safety of once-daily ritonavir-boosted atazanavir or darunavir in combination with a dual nucleos(t)ide analogue backbone in HIV-1-infected combined ART (cART)-naive patients with severe immunosuppression: a 48 week, non-comparative, randomized, multicentre trial (IMEA 040 DATA trial). J Antimicrob Chemother 2016; 71:2252-61. [PMID: 27068399 DOI: 10.1093/jac/dkw103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/29/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Boosted PIs are commonly prescribed in patients presenting with advanced HIV infection. We assessed the efficacy and tolerability of once-daily ritonavir-boosted atazanavir or darunavir plus two NRTIs in HIV-1-infected ART-naive patients with severe immunosuppression, targeting at least an 85% success rate at week 48. METHODS This 48 week, open-label, non-comparative, randomized, multicentre trial included ART-naive patients with CD4 cell counts <200 cells/mm(3), with plasma HIV-1 RNA >1000 copies/mL and without genotypic mutations conferring resistance to the study drugs. Patients were randomized (1:1) to receive once-daily atazanavir/ritonavir (300/100 mg) or darunavir/ritonavir (800/100 mg) plus tenofovir disoproxil fumarate/emtricitabine or abacavir/lamivudine. The primary endpoint was treatment success, defined as plasma HIV-1 RNA ≤50 copies/mL at week 48 and no permanent PI/ritonavir discontinuation. The study was registered with ClinicalTrials.gov (NCT01928407). RESULTS One hundred and twenty patients were enrolled: 77% were men, 30% were born in Africa and 39% had AIDS. The median baseline CD4 and plasma HIV-RNA values were 69 cells/mm(3) and 5.4 log10 copies/mL. All but four patients received tenofovir disoproxil fumarate/emtricitabine. The week 48 treatment success rate was 66% (95% CI 54%-78%) with atazanavir/ritonavir and 80% (95% CI 68%-89%) with darunavir/ritonavir. The median CD4 cell count increased similarly in the two groups (Δweek 48 to week 0: +194 cells/mm(3)). Adverse events occurred in 23 and 18 patients, respectively. CONCLUSIONS Despite good adherence, neither study regimen reached the predefined objective, suggesting a need for more potent regimens for patients with advanced HIV infection.
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Affiliation(s)
- Laurence Slama
- Tenon APHP, Maladies Infectieuses, F-75020, Paris, France
| | - Roland Landman
- Bichat Claude Bernard, APHP, Maladies Infectieuses, F-75018 Paris, France Institut de Médecine et d'Epidémiologie Appliquées, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France Institut de Médecine et d'Epidémiologie Appliquées, UMR 1137, Inserm, F-75018, Paris, France
| | - Lambert Assoumou
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - Aida Benalycherif
- Institut de Médecine et d'Epidémiologie Appliquées, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France
| | - Assia Samri
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, U1135, CIMI, F-75013, Paris, France
| | - Véronique Joly
- Bichat Claude Bernard, APHP, Maladies Infectieuses, F-75018 Paris, France
| | - Gilles Pialoux
- Tenon APHP, Maladies Infectieuses, F-75020, Paris, France
| | - Nadia Valin
- Saint Antoine APHP, Maladies Infectieuses, F-75012 Paris, France
| | - André Cabié
- Fort de France, Maladies Infectieuses, Martinique, France
| | - Claudine Duvivier
- Necker Enfants malades, APHP, Maladies Infectieuses, Centre d'infectiologie Necker-Pasteur, Paris, France
| | | | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France APHP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - Gilles Peytavin
- IAME, UMR 1137, INSERM et Université Paris Diderot, Sorbonne Paris Cité et AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, F-75018 Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - Pierre-Marie Girard
- Institut de Médecine et d'Epidémiologie Appliquées, UMR 1137, Inserm, F-75018, Paris, France Saint Antoine APHP, Maladies Infectieuses, F-75012 Paris, France
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Leblanc J, Rousseau A, Hejblum G, Durand-Zaleski I, de Truchis P, Lert F, Costagliola D, Simon T, Crémieux AC. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial. BMC Infect Dis 2016; 16:51. [PMID: 26831332 PMCID: PMC4736610 DOI: 10.1186/s12879-016-1377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. METHODS/DESIGN DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016. DISCUSSION The DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02127424 (29 April 2014).
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Université Paris Saclay - Université Versailles Saint-Quentin, Doctoral School of Public Health (EDSP), UMR 1173, F92380, Garches, France.
| | - Alexandra Rousseau
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Isabelle Durand-Zaleski
- AP-HP, Hôpital Hôtel-Dieu, URC Eco Île-de-France, F75004, Paris, France. .,Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, F75019, Paris, France. .,AP-HP, Hôpital Henri-Mondor, Santé publique, F94010, Créteil, France.
| | - Pierre de Truchis
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France.
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for research in Epidemiology and population health, U 1018, F94800, Villejuif, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Tabassome Simon
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of clinical pharmacology and Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, F75018, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France. .,Université Versailles Saint-Quentin, UMR 1173, F92380, Garches, France.
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Cox JA, Kiggundu D, Elpert L, Meintjes G, Colebunders R, Alamo S. Temporal trends in death causes in adults attending an urban HIV clinic in Uganda: a retrospective chart review. BMJ Open 2016; 6:e008718. [PMID: 26739722 PMCID: PMC4716149 DOI: 10.1136/bmjopen-2015-008718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To study temporal trends of mortality in HIV-infected adults who attended an HIV clinic in Kampala, Uganda, between 2002 and 2012. DESIGN Descriptive retrospective study. METHODS Two doctors independently reviewed the clinic database that contained information derived from the clinic files and assigned one or more causes of death to each patient >18 years of age with a known date of death. Four cause-of-death categories were defined: 'communicable conditions and AIDS-defining malignancies', 'chronic non-communicable conditions', 'other non-communicable conditions' and 'unknown'. Trends in cause-of-death categories over time were evaluated using multinomial logistic regression with year of death as an independent continuous variable. RESULTS 1028 deaths were included; 38% of these individuals were on antiretroviral therapy (ART). The estimated mortality rate dropped from 21.86 deaths/100 person years of follow-up (PYFU) in 2002 to 1.75/100 PYFU in 2012. There was a significant change in causes of death over time (p<0.01). Between 2002 and 2012, the proportion of deaths due to 'communicable conditions and AIDS-defining malignancies' decreased from 84% (95% CI 74% to 90%) to 64% (95% CI 53% to 74%) and the proportion of deaths due to 'chronic non-communicable conditions', 'other non-communicable conditions' and a combination of 'communicable and non-communicable conditions' increased. Tuberculosis (TB) was the main cause of death (34%). Death from TB decreased over time, from 43% (95% CI 32% to 53%) in 2002 to a steady proportion of approximately 25% from 2006 onwards (p<0.01). CONCLUSIONS Mortality rate decreased over time. The proportion of deaths from communicable conditions and AIDS-defining malignancies decreased and from non-communicable diseases, both chronic and non-chronic, increased. Nevertheless, communicable conditions and AIDS-defining malignancies continued to cause the majority of deaths, with TB as the main cause. Ongoing monitoring of cause of death is warranted and strategies to decrease mortality from TB and other common opportunistic infections are essential.
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Affiliation(s)
- Janneke A Cox
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Daniel Kiggundu
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lana Elpert
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Graeme Meintjes
- Department of Medicine, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Stella Alamo
- Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda
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Reasons for late presentation to HIV care in Switzerland. J Int AIDS Soc 2015; 18:20317. [PMID: 26584954 PMCID: PMC4653319 DOI: 10.7448/ias.18.1.20317] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 01/17/2023] Open
Abstract
Introduction Late presentation to HIV care leads to increased morbidity and mortality. We explored risk factors and reasons for late HIV testing and presentation to care in the nationally representative Swiss HIV Cohort Study (SHCS). Methods Adult patients enrolled in the SHCS between July 2009 and June 2012 were included. An initial CD4 count <350 cells/µl or an AIDS-defining illness defined late presentation. Demographic and behavioural characteristics of late presenters (LPs) were compared with those of non-late presenters (NLPs). Information on self-reported, individual barriers to HIV testing and care were obtained during face-to-face interviews. Results Of 1366 patients included, 680 (49.8%) were LPs. Seventy-two percent of eligible patients took part in the survey. LPs were more likely to be female (p<0.001) or from sub-Saharan Africa (p<0.001) and less likely to be highly educated (p=0.002) or men who have sex with men (p<0.001). LPs were more likely to have their first HIV test following a doctor's suggestion (p=0.01), and NLPs in the context of a regular check-up (p=0.02) or after a specific risk situation (p<0.001). The main reasons for late HIV testing were “did not feel at risk” (72%), “did not feel ill” (65%) and “did not know the symptoms of HIV” (51%). Seventy-one percent of the participants were symptomatic during the year preceding HIV diagnosis and the majority consulted a physician for these symptoms. Conclusions In Switzerland, late presentation to care is driven by late HIV testing due to low risk perception and lack of awareness about HIV. Tailored HIV testing strategies and enhanced provider-initiated testing are urgently needed.
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Diaz RS, Inocêncio LA, Sucupira MCA, Pereira AA, Hunter J, Ferreira JE, Araújo LV, Souza DFC, Sabino EC. The Virological and Immunological Characteristics of the HIV-1-Infected Population in Brazil: From Initial Diagnosis to Impact of Antiretroviral Use. PLoS One 2015; 10:e0139677. [PMID: 26509441 PMCID: PMC4624810 DOI: 10.1371/journal.pone.0139677] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Immunological and virological status of HIV-infected individuals entering the Brazilian public system over time was analyzed. We evaluated the impact of ART on virological, immunological and antiretroviral resistance over time. Methods CD4+ T cell counts, viral loads and genotypes from patients over 13 years old from 2001–2011 were analyzed according to demographic data. We compared groups using parametric t-tests and linear regression analysis in the R statistical software language. Results Mean baseline CD4+ T cell counts varied from 348 (2003) to 389 (2009) and was higher among women (p = 1.1 x 10−8), lower in older patients (p< 1 x 10−8) and lower in less developed regions (p = 1.864 x 10−5). Percentage of treated patients with undetectable viral loads increased linearly from 46% (2001) to 77% (2011), was lower among women (p = 2.851 x 10−6), younger ages (p = 1 x 10−3), and in less developed regions (p = 1.782 x 10−4). NRTI acquired resistance was 86% in 2001–3 and decreased over time. NNRTI resistance increased from 2001-3(50%) to 2006–9 (60%), PI resistance decreased from 2001–3 (60%) to 2009 (40%), and 3-class resistance was stable over time around 25%. Subtype prevalence comprised B (75.3%), B/F recombinants (12.2%), C (5.7%), F (5.3%) and B/C recombinants (1.5%), with regional variations. Three-class resistance was 26.5% among Bs, 22.4% among Fs and 17.2% among Cs. Conclusions HIV diagnosis occurs late, especially among elderly Brazilians. Younger individuals need special attention due to poor virological response to treatment. Antiretroviral Resistance profile is subtype related.
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Affiliation(s)
| | - Lilian A. Inocêncio
- Federal University of São Paulo, São Paulo, Brazil
- Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil
| | | | | | - James Hunter
- Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Denise F. C. Souza
- Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil
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Fraisse T, Fourcade C, Brazes-Sanz J, Koumar Y, Lavigne JP, Sotto A, Laureillard D. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners. Int J STD AIDS 2015; 27:1005-12. [PMID: 26429893 DOI: 10.1177/0956462415605413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.
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Affiliation(s)
- Thibaut Fraisse
- Department of Geriatric Medicine, General Hospital, Alès, France
| | - Camille Fourcade
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Yatrika Koumar
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Albert Sotto
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
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Diphtheria, tetanus, poliomyelitis, yellow fever and hepatitis B seroprevalence among HIV1-infected migrants. Results from the ANRS VIHVO vaccine sub-study. Vaccine 2015. [PMID: 26209841 DOI: 10.1016/j.vaccine.2015.07.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Few data are available on the seroprotection status of HIV1-infected patients with respect to vaccine-preventable diseases. OBJECTIVE To describe, in a population of HIV1-infected migrants on stable, effective ART therapy, the seroprevalence of diphtheria, poliomyelitis, tetanus, yellow fever antibodies and serostatus for hepatitis B, and to identify factors associated with seroprotection. Vaccine responses against diphtheria, tetanus, poliomyelitis and yellow fever were also studied. METHODS Sub-Saharan African patients participating in the ANRS-VIHVO cohort were enrolled prior to travel to their countries of origin. Serologic analyses were performed in a central laboratory before and after the trip. Univariate and multivariate logistic regression was used to identify factors associated with initial seroprotection. RESULTS 250 patients (99 men and 151 women) were included in the seroprevalence study. Median age was 45 years (IQR 39-52), median CD4 cell count was 440/μL (IQR 336-571), and 237 patients (95%) had undetectable HIV1 viral load. The initial seroprevalence rates were 69.0% (95%CI 63.2-74.7) for diphtheria, 70.7% (95%CI 65.0-76.3) for tetanus, and 85.9% (95%CI 81.6-90.2) for yellow fever. Only 64.4% (95%CI 58.5-70.3) of patients had protective antibody titers against all three poliomyelitis vaccine strains before travel. No serological markers of hepatitis B were found in 18.6% of patients (95%CI 13.7-23.3). Patient declaration of prior vaccination was the only factor consistently associated with initial seroprotection. CONCLUSIONS We found a low prevalence of seroprotection against diphtheria, poliomyelitis, tetanus and hepatitis B. HIV infected migrants living in France and traveling to their native countries need to have their vaccine schedule completed.
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Abstract
OBJECTIVE Expanded HIV testing coverage could result in earlier diagnosis of HIV, along with reduced morbidity, mortality and onward HIV transmission. DESIGN Longitudinal analysis of aggregate, population-based surveillance data within New York City (NYC) ZIP codes. METHODS We examined new HIV diagnoses and recent HIV testing to examine whether changes in recent HIV testing coverage (last 12 months) were associated with changes in late HIV diagnosis rates within NYC ZIP codes during 2003-2010, a period of expansion of HIV testing in NYC. RESULTS Overall, recent HIV testing coverage increased from 23 to 31% during 2003-2010, while the rate of late HIV diagnoses decreased from 14.9 per 100 000 to 10.6 per 100 000 population. Within ZIP codes, each 10% absolute increase in recent HIV testing coverage was associated with a 2.5 per 100 000 absolute decrease in the late HIV diagnosis rate. ZIP codes with the largest changes in HIV testing coverage among men were more likely to have the largest (top quartile) declines in late HIV diagnosis rates among men [adjusted odds ratio (aOR)men = 4.0; 95% confidence interval (95% CI) 1.5-10.8], compared with ZIP codes with no or small changes in HIV testing coverage. This association was not significant for women (aORwomen = 1.4; 95% CI 0.50-4.3). Significant geographic disparities in late HIV diagnosis rates persisted in 2009/2010. CONCLUSION Increases in recent HIV testing coverage may have reduced late HIV diagnoses among men. Persistent geographic disparities underscore the need for continued expansion of HIV testing to promote earlier HIV diagnosis.
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Suligoi B, Zucchetto A, Grande E, Camoni L, Dal Maso L, Frova L, Virdone S, Boros S, Pappagallo M, Taborelli M, Regine V, De Paoli P, Serraino D. Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy. BMC Infect Dis 2015; 15:229. [PMID: 26067992 PMCID: PMC4464724 DOI: 10.1186/s12879-015-0960-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis). METHODS A population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95% confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models. RESULTS Of the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9%) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2% in PWA diagnosed in 1999-2000 to 82.9% in 2009, while the 5-year survival augmented from 60.7% in PWA diagnosed in 1999-2000 to 65.4% for PWA diagnosed in 2005-2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95% CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95% CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm(3) at AIDS diagnosis (OR = 1.87, 95% CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95% CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95% CI: 3.37-5.27). CONCLUSIONS Our study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Antonella Zucchetto
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Enrico Grande
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Laura Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Luigino Dal Maso
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Luisa Frova
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Saverio Virdone
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Stefano Boros
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Marilena Pappagallo
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Martina Taborelli
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Paolo De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy.
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
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Cerrato E, Calcagno A, D'Ascenzo F, Biondi-Zoccai G, Mancone M, Grosso Marra W, Demarie D, Omedè P, Abbate A, Bonora S, DiNicolantonio JJ, Estrada V, Escaned J, Moretti C, Gaita F. Cardiovascular disease in HIV patients: from bench to bedside and backwards. Open Heart 2015; 2:e000174. [PMID: 25815207 PMCID: PMC4368980 DOI: 10.1136/openhrt-2014-000174] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 01/25/2023] Open
Abstract
HIV patients are exposed to a higher risk of adverse cardiovascular events, due to complex interactions between traditional risk factors and HIV infection itself in terms of ongoing endothelial dysfunctional immune activation/inflammation and increased risk of thrombosis. On the other hand, long-span antiretroviral therapy administration still raises questions on its long-term safety in an era in which life expectancy is becoming longer and longer while treatment of non-HIV-related serious events is increasingly raising concern. In this article, we will critically analyse the current knowledge of pathological and clinical aspects pertaining to the increased risk of cardiovascular events associated with HIV.
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Affiliation(s)
- Enrico Cerrato
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
- Wegmans Pharmacy, Ithaca, New York, USA
| | - Andrea Calcagno
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Massimo Mancone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Walter Grosso Marra
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
| | - Daniela Demarie
- Cardiology Department, Maria Vittoria Hospital, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
| | | | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | | | - Vicente Estrada
- Infectious Disease Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Javier Escaned
- Interventional Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Claudio Moretti
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
| | - Fiorenzo Gaita
- Division of Cardiology, University of Turin, Turin, Italy (www.cardiogroup.org)
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de Monteynard LA, Dray-Spira R, de Truchis P, Grabar S, Launay O, Meynard JL, Khuong-Josses MA, Gilquin J, Rey D, Simon A, Pavie J, Mahamat A, Matheron S, Costagliola D, Abgrall S. Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France. PLoS One 2015; 10:e0118492. [PMID: 25734445 PMCID: PMC4348541 DOI: 10.1371/journal.pone.0118492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/12/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care. Methods Antiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002–2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200–349, 350-499, ≥500/μL), we examined the crude time until cART initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection. Results Among 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1–28) and 20% (95%CI, 2–38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM. Conclusion SSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.
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Affiliation(s)
- Laure-Amélie de Monteynard
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Pierre de Truchis
- AP-HP, Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond-Poincaré, Département de Médecine Aigüe Spécialisée, Garches, France
| | - Sophie Grabar
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité de Biostatistique et Epidémiologie, Paris, France
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Cochin, Paris, France
| | - Jean-Luc Meynard
- AP-HP, Hôpital Saint Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Marie-Aude Khuong-Josses
- Centre Hospitalier Saint-Denis, Hôpital Delafontaine, Service des Maladies Infectieuses et Tropicales, Saint-Denis, France
| | - Jacques Gilquin
- AP-HP, Hôpital Hôtel-Dieu, Unité d'immunoinfectiologie, Paris, France
| | - David Rey
- Hôpitaux Universitaire Strasbourg, Centre de Soins de l'Infection par le VIH, Strasbourg, France
| | - Anne Simon
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de médecine interne, Paris, France
| | - Juliette Pavie
- AP-HP, Hôpital Européen Georges Pompidou, Service d'immunologie clinique, Paris, France
| | - Aba Mahamat
- Centre Hospitalier Andrée Rosemon, Service des Maladies Infectieuses et Tropicales, Cayenne, France
| | - Sophie Matheron
- Université Paris Diderot, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Sophie Abgrall
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France
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Johnston RE, Heitzeg MM. Sex, age, race and intervention type in clinical studies of HIV cure: a systematic review. AIDS Res Hum Retroviruses 2015; 31:85-97. [PMID: 25313793 DOI: 10.1089/aid.2014.0205] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This systematic review was undertaken to determine the extent to which adult subjects representing sex (female), race (nonwhite), and age (>50 years) categories are included in clinical studies of HIV curative interventions and thus, by extension, the potential for data to be analyzed that may shed light on the influence of such demographic variables on safety and/or efficacy. English-language publications retrieved from PubMed and from references of retrieved papers describing clinical studies of curative interventions were read and demographic, recruitment year, and intervention-type details were noted. Variables of interest included participation by sex, age, and race; changes in participation rates by recruitment year; and differences in participation by intervention type. Of 151 publications, 23% reported full demographic data of study enrollees, and only 6% reported conducting efficacy analyses by demographic variables. Included studies recruited participants from 1991 to 2011. No study conducted safety analyses by demographic variables. The representation of women, older people, and nonwhites did not reflect national or international burdens of HIV infection. Participation of demographic subgroups differed by intervention type and study location. Rates of participation of demographic groups of interest did not vary with time. Limited data suggest efficacy, particularly of early therapy initiation followed by treatment interruption, may vary by demographic variables, in this case sex. More data are needed to determine associations between demographic characteristics and safety/efficacy of curative interventions. Studies should be powered to conduct such analyses and cure-relevant measures should be standardized.
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Affiliation(s)
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Dal Maso L, Suligoi B, Franceschi S, Braga C, Buzzoni C, Polesel J, Zucchetto A, Piselli P, Falcini F, Caldarella A, Zanetti R, Vercelli M, Guzzinati S, Russo A, Tagliabue G, Iachetta F, Ferretti S, Limina RM, Mangone L, Michiara M, Stracci F, Pirino DR, Piffer S, Giacomin A, Vitarelli S, Mazzoleni G, Iannelli A, Contrino ML, Fusco M, Tumino R, Fanetti AC, De Paoli P, Decarli A, Serraino D. Survival after cancer in Italian persons with AIDS, 1986-2005: a population-based estimation. J Acquir Immune Defic Syndr 2014; 66:428-35. [PMID: 24798769 DOI: 10.1097/qai.0000000000000184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancer. METHODS PWA with cancer at AIDS diagnosis or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living, and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CIs) were estimated. RESULTS We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986-2005. Between 1986 and 1995, and 1996 and 2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3 to 6.1) to 2.9 (95% CI: 2.6 to 3.3). During 1996-2005, HRs were 2.0 (95% CI: 1.4 to 2.9) for Kaposi sarcoma, 3.4 (95% CI: 2.9 to 4.1) for non-Hodgkin lymphoma, and 2.4 (95% CI: 1.4 to 4.0) for cervical cancer. HRs were 2.5 (95% CI: 2.1 to 3.1) for all non-AIDS-defining cancers, 5.9 (95% CI: 3.1 to 11.2) for Hodgkin lymphoma, and 7.3 (95% CI: 2.8 to 19.2) for nonmelanoma skin cancer. A ≤3-fold survival difference was found for cancers of the stomach, liver, anus, lung, brain, and the most aggressive lymphoma subtypes. CONCLUSIONS The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA can be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.
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Affiliation(s)
- Luigino Dal Maso
- *Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, Italy; †Istituto Superiore di Sanità, Rome, Italy; ‡International Agency for Research on Cancer, Lyon, France; §AIRTUM database, Florence, Italy; ‖Tuscany Cancer Registry, UO di epidemiologia clinica e descrittiva, Istituto per lo studio e la prevenzione oncologica, Florence, Italy; ¶Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; #Department of Epidemiology, INMI "L Spallanzani" IRCCS, Rome, Italy; **Romagna Cancer Registry, Cancer Institute of Romagna IRCCS, Meldola, Italy; ††Piedmont Cancer Registry, Oncology Prevention Center (CPO), Torino, Italy; ‡‡Registro Tumori Regione Liguria, IRCSS Azienda Università Ospedale San Martino-IST Istituto nazionale ricerca sul cancro e Dipartimento di scienze della salute, Genoa University, Genoa, Italy; §§Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy; ‖‖Milan Cancer Registry, Milan Health Authority, Epidemiology Unit, Milan, Italy; ¶¶Lombardia Cancer Registry, Varese Province, National Cancer Institute, Milan, Italy; ##Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy; ***Ferrara Cancer Registry, Ferrara University, Ferrara, Italy; †††Brescia Health Unit, Cancer Registry, Brescia, Italy; ‡‡‡S.C. Statistica, qualità e studi clinici IRCCS, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; §§§Parma Province Cancer Registry, University Hospital Parma, Parma, Italy; ‖‖‖Umbria Cancer Registry, Department of Medical and Surgical Specialties, and Public Health, Section of Public Health, Perugia University, Perugia, Italy; ¶¶¶Cancer Registry of Sassari, Sassari, Italy; ###Registro Tumori della Provincia di Trento, Servizio di Epidemiologia Clinica e Valutativa, Trento, Italy; ****Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy; †††
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Assessing characteristics of hidden epidemics to design the most efficient HIV testing strategies. AIDS 2014; 28:1831-3. [PMID: 25006827 DOI: 10.1097/qad.0000000000000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
BACKGROUND Describing the undiagnosed HIV-infected population is essential for guiding HIV screening policy, implementing interventions, and resource planning. METHODS We used French national HIV surveillance data and a back-calculation approach to estimate the number of undiagnosed HIV-infected individuals in France and the distribution of time since HIV infection among undiagnosed individuals. We also used data on CD4⁺ cell count decline to assess the CD4⁺ cell count distribution among undiagnosed individuals. RESULTS We estimated that 29,000 [95% confidence interval (CI): 24,200-33,900] individuals were living with undiagnosed HIV infection at the end of 2010. Of these, 28.7% (95% CI: 27.1-30.4) were infected less than a year ago, 16.4% (95% CI: 15.0-17.8) more than 5 years ago, and 59.6% (95% CI: 59.2-59.8) were eligible for antiretroviral treatment (CD4⁺ cell count less than 500 cells/μl) according to the 2010 French guidelines. Men represented 70.0% of the undiagnosed HIV-infected individuals and had lower CD4⁺ cell counts than women. The numbers of undiagnosed infections in MSM, non-French national heterosexuals, and French national heterosexuals were similar (9200, 9300, 10,000, respectively). However, because of differences in group size, undiagnosed HIV prevalence varied significantly between these groups (2.95, 0.36, 0.03%, respectively; P less than 0.001). CONCLUSION Our findings suggest that many undiagnosed HIV-infected individuals were eligible for treatment and, thus, lack of HIV diagnosis is a lost chance for them; many more heterosexuals than MSM will need to be tested to find those undiagnosed; and universal screening of men may be cost-effective, especially in the areas most affected by the epidemic, such as the Paris region.
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Wilson KD, Dray-Spira R, Aubrière C, Hamelin C, Spire B, Lert F. Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France. AIDS Care 2014; 26 Suppl 1:S83-93. [PMID: 24731147 DOI: 10.1080/09540121.2014.906554] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Correlates of late presentation (LP) for HIV infection in Metropolitan France and French overseas departments (FODs) were assessed among HIV-infected patients recently diagnosed, using data from a large cross-sectional survey, representative of the French HIV-infected population, conducted in 2011. LP was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 < 350/mm(3) and presentation with advanced disease (PAD) was defined as presentation with either clinical AIDS events or CD4 < 200/mm(3). Correlates of LP/PAD were assessed through logistic modelling, separately in Metropolitan France and FODs. In Metropolitan France, 47.7% of participants were late presenters and 29.3% presented with advanced disease. LP was more frequent among male and female migrants from sub-Saharan Africa (SSA; 58.5% and 56.4%) and non-African heterosexual males (61.8%) than among men who have sex with men (34.8%). In FODs, 53.2% of participants were late presenters and 36.8% presented with an advanced disease. LP was more frequent among men than women (60.6% vs. 45.3%) and among those with a lower level of education (56.6% vs. 47.5%). A consistent positive association was found in adjusted analyses between LP/PAD and increasing age at diagnosis among all subpopulations, in both settings. In Metropolitan France, among men who have sex with men, those self-declaring as bisexual were at higher risk of LP/PAD; among non-African heterosexual males and females, religiosity was associated with increased risk of LP/PAD; and among SSA migrants, those diagnosed within the year following their arrival in France were at higher risk of LP/PAD. Older age at diagnosis is a major risk factor for LP/PAD independently of any other socio-demographic characteristics. Promotion of HIV testing should be renewed to target each subgroup at risk while paying a particular attention to middle-aged or older adults whose attitudes and beliefs towards HIV/AIDS might prevent them from seeking testing.
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Affiliation(s)
- Kayigan d'Almeida Wilson
- a Department of Social Epidemiology, INSERM, UMR_S 1136 , Pierre Louis Institute of Epidemiology and Public Health , Paris , France
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