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Candevir A, Kuscu F, Kurtaran B, Kömür S, İnal AS, Ertürk D, Taşova Y. Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey. Int J Gen Med 2023; 16:4227-4234. [PMID: 37745135 PMCID: PMC10516126 DOI: 10.2147/ijgm.s424561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
Background Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected. Methods The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as "not late". Results Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004). Conclusion HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.
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Affiliation(s)
| | - Ferit Kuscu
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | | | - Süheyla Kömür
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Ayşe Seza İnal
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Damla Ertürk
- Infectious Diseases, Health Sciences University Izmir Tepecik Education and Research Hospital, İzmir, Türkiye
| | - Yeşim Taşova
- Infectious Diseases, Çukurova University, Adana, Türkiye
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Puła J, Kowalska J, Paciorek M, Bednarska A, Skrzat‐Klapaczyńska A, Horban A. Is the definition of late diagnosis correct? HIV Med 2022; 24:616-619. [PMID: 36478347 DOI: 10.1111/hiv.13450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The study analysed 1711 patients of the Hospital for Infectious Diseases in Warsaw diagnosed with HIV infection in 2008-2010 and 2016-2018. Research was conducted examining the changes in CD4 cell counts before starting antiretroviral (ARV) treatment in order to find people who were misclassified as late-diagnosed. METHODS Patients with late diagnosis were distinguished on the basis of the consensus definition. The Mann-Whitney U-test was used to analyse the change in CD4 cell counts before starting ARV treatment. RESULTS In the years 2008-2010, the CD4 count was remeasured before starting ARV treatment in 90 late-diagnosed patients. The median change in the CD4 count was 22 cells/μL. In 49 of these, the number of CD4 cells spontaneously increased before the start of treatment. We can suspect that these patients were misclassified as late-diagnosed. CONCLUSIONS The consensus definition of late diagnosis often leads to overestimation of the number of late-diagnosed patients. The crucial problem is a transient decline in the CD4 lymphocyte count in the acute phase of HIV infection. A potential solution is to introduce serum HIV viral load measurement into the definition.
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Affiliation(s)
- Joanna Puła
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
| | - Justyna Kowalska
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
| | - Marcin Paciorek
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
| | - Agnieszka Bednarska
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
| | - Agata Skrzat‐Klapaczyńska
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
| | - Andrzej Horban
- Department of Infectious Diseases for Adults Medical University of Warsaw Warsaw Poland
- Hospital for Infectious Diseases Warsaw Poland
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Croxford S, Stengaard AR, Brännström J, Combs L, Dedes N, Girardi E, Grabar S, Kirk O, Kuchukhidze G, Lazarus JV, Noori T, Pharris A, Raben D, Rockstroh JK, Simões D, Sullivan AK, Van Beckhoven D, Delpech VC. Late diagnosis of HIV: An updated consensus definition. HIV Med 2022; 23:1202-1208. [PMID: 36347523 PMCID: PMC10100195 DOI: 10.1111/hiv.13425] [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: 08/01/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In recent years, HIV testing frequency has increased, resulting in more people being diagnosed during seroconversion with a temporarily low CD4 count. Using the current consensus definition of late HIV presentation ('presenting for care with a CD4 count < 350 cells/μL or an AIDS-defining event, regardless of CD4 count') these individuals would be incorrectly assigned as being diagnosed late. METHODS In spring 2022, a European expert group convened to revise the current late HIV presentation consensus definition. A survey on data availability to apply this revised definition was sent to nominated European focal points responsible for HIV surveillance (n = 53). RESULTS Experts agreed that the updated definition should refer to late HIV diagnosis rather than presentation and include the following addition: People with evidence of recent infection should be reclassified as 'not late', with evidence of recent infection considered hierarchically. The individual must have: (i) laboratory evidence of recent infection; (ii) a last negative HIV test within 12 months of diagnosis; or (iii) clinical evidence of acute infection. People with evidence of being previously diagnosed abroad should be excluded. A total of 18 countries responded to the survey; 83% reported capturing CD4 count and/or AIDS at diagnosis through national surveillance, 67% captured last negative test and/or previous HIV diagnosis, 61% captured seroconversion illness at diagnosis and 28% captured incident antibody results. CONCLUSIONS Accurate data on late diagnosis are important to describe the effects of testing programmes. Reclassification of individuals with recent infection will help to better identify populations most at risk of poor HIV outcomes and areas for intervention.
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Affiliation(s)
| | - Annemarie Rinder Stengaard
- Centre of Excellence for Health, Immunity and Infections - CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Johanna Brännström
- Institution of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,EuroTEST Steering Committee, Copenhagen, Denmark.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Lauren Combs
- Centre of Excellence for Health, Immunity and Infections - CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikos Dedes
- EuroTEST Steering Committee, Copenhagen, Denmark.,European AIDS Treatment Group, Brussels, Belgium
| | - Enrico Girardi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
| | - Ole Kirk
- Centre of Excellence for Health, Immunity and Infections - CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Giorgi Kuchukhidze
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jeffrey V Lazarus
- EuroTEST Steering Committee, Copenhagen, Denmark.,ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections - CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jürgen K Rockstroh
- EuroTEST Steering Committee, Copenhagen, Denmark.,European AIDS Clinical Society, Brussels, Belgium.,University Hospital Bonn, Bonn, Germany
| | - Daniel Simões
- EuroTEST Steering Committee, Copenhagen, Denmark.,EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Coalition PLUS, Paris, France
| | - Ann K Sullivan
- UK Health Security Agency, London, UK.,EuroTEST Steering Committee, Copenhagen, Denmark.,European AIDS Clinical Society, Brussels, Belgium.,Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Valerie C Delpech
- UK Health Security Agency, London, UK.,EuroTEST Steering Committee, Copenhagen, Denmark
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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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Epalza C, Domínguez-Rodríguez S, Cervantes E, Jiménez de Ory S, Frick MA, Fortuny C, Soler-Palacín P, Prieto-Tato L, Sainz T, Carreras-Abad C, Montero Alonso M, de Zárraga Fernández MA, Ocampo A, Rojo P, Navarro ML. Factors associated with late presentation for HIV care in adolescents in Spain. HIV Med 2022; 23:1195-1201. [PMID: 36178091 DOI: 10.1111/hiv.13407] [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: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Late presenters (LP) for HIV care are associated with higher morbidity and mortality rates. Our aim was to describe the characteristics associated with LP among adolescents in Spain. Identification of particular features may help in the design of strategies for improvement. METHODS Late-presenting adolescents diagnosed at 12-19 years of age and enrolled in the Spanish paediatric and adult HIV/AIDS cohorts (CoRIS-CoRISpe) from 2004 to 2019 were selected. LP were defined as those presenting with CD4 count <350 cells/mm3 or an AIDS-defining event in the 6 months following HIV diagnosis. Confirmed low CD4 count in the next 3 months and before antiretroviral treatment initiation defined confirmed LP (cLP). RESULTS Of 410 adolescents newly diagnosed with HIV, 303 (73.9%) had available data for assessing late presentation. Of these, 34.7% were LP and 23.7% were cLP. The median CD4 count for cLP was 235 cells/mm3 (interquartile range 122-285). In a multivariable analysis, adolescents at the highest risk of late presentation were early adolescents (age 12-14 years; odds ratio [OR] 6.50; 95% confidence interval [CI] 2.61-18.2), middle adolescents (age 15-17 years; OR 1.85; 95% CI 0.92-3.59), and adolescents born abroad (OR 1.71; 95% CI 0.97-3.00), particularly those of African origin (OR 3.08; 95% CI 1.38-6.79). CONCLUSIONS One-quarter of adolescents presented late for HIV care in Spain. Early adolescents, middle adolescents, and those born abroad presented a sevenfold, twofold, and twofold higher risk of being cLP, respectively. Enhancing the awareness of HIV risk and the access to care, especially for younger and foreign adolescents, could help reduce late presentation and tackle the adolescent HIV epidemic.
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Affiliation(s)
- Cristina Epalza
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Eloisa Cervantes
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Santiago Jiménez de Ory
- Grupo de Enfermedades Infecciosas en la Población Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón Madrid, Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Clàudia Fortuny
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain.Departament de Pediatria, Universitat de Barcelona Facultat de Medicina, Barcelona, Spain
| | - Pere Soler-Palacín
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Luis Prieto-Tato
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Talía Sainz
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Department of Pediatrics. Hospital Universitario La Paz - IdiPAZ Research Institute. Universidad Autónoma de Madrid, Spain
| | - Clara Carreras-Abad
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Montero Alonso
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | | | - Antonio Ocampo
- Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Maria Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). UCM, Madrid, Spain
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Kirwan PD, Croxford S, Aghaizu A, Murphy G, Tosswill J, Brown AE, Delpech VC. Re-assessing the late HIV diagnosis surveillance definition in the era of increased and frequent testing. HIV Med 2022; 23:1127-1142. [PMID: 36069144 PMCID: PMC7613879 DOI: 10.1111/hiv.13394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Late HIV diagnosis (CD4 <350 cells/mm3 ) is a key public health metric. In an era of more frequent testing, the likelihood of HIV diagnosis occurring during seroconversion, when CD4 counts may dip below 350, is greater. We applied a correction, considering markers of recent infection, and re-assessed 1-year mortality following late diagnosis. METHODS We used national epidemiological and laboratory surveillance data from all people diagnosed with HIV in England, Wales, and Northern Ireland (EW&NI). Those with a baseline CD4 <350 were reclassified as 'not late' if they had evidence of recent infection (recency test and/or negative test within 24 months). A correction factor (CF) was the number reclassified divided by the number with a CD4 <350. RESULTS Of the 32 227 people diagnosed with HIV in EW&NI between 2011 and 2019 with a baseline CD4 (81% of total), 46% had a CD4 <350 (uncorrected late diagnosis rate): 34% of gay and bisexual men (GBM), 65% of heterosexual men, and 56% of heterosexual women. Accounting for recency test and/or prior negative tests gave a 'corrected' late diagnosis rate of 39% and corresponding CF of 14%. The CF increased from 10% to 18% during 2011-2015, then plateaued, and was larger among GBM (25%) than heterosexual men and women (6% and 7%, respectively). One-year mortality among people diagnosed late was 329 per 10 000 after reclassification (an increase from 288/10 000). CONCLUSIONS The case-surveillance definition of late diagnosis increasingly overestimates late presentation, the extent of which differs by key populations. Adjustment of late diagnosis is recommended, particularly for frequent testers such as GBM.
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Affiliation(s)
- Peter D Kirwan
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge,United Kingdom Health Security Agency, London,Corresponding author Contact details: Peter Kirwan, United Kingdom Health Security Agency, London, NW9 5EQ Phone: +44 (0)7837 723563,
| | | | | | - Gary Murphy
- United Kingdom Health Security Agency, London
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van Wijhe M, Fischer TK, Fonager J. Identification of risk factors associated with national transmission and late presentation of HIV-1, Denmark, 2009 to 2017. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34823639 PMCID: PMC8619873 DOI: 10.2807/1560-7917.es.2021.26.47.2002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundDespite availability of pre-exposure prophylaxis (PrEP), the incidence of HIV-1 in Europe remained stable the past decade. Reduction of new HIV-1 infections requires more knowledge about the profiles of high-risk transmitters and late presenters (LP).AimWe aimed to investigate risk factors associated with HIV-1 transmission clusters and late presentation with HIV-1 in Denmark.MethodsBlood samples and epidemiological information were collected from newly diagnosed HIV-1 patients between 2009 and 2017. We genotyped pol genes and performed phylogenetic analyses to identify clusters. Risk factors for clustering and LP were investigated with partial proportional odds and logistic regression. Covariates included transmission mode, HIV-1 subtype, age, origin and cluster activity.ResultsWe included 1,040 individuals in the analysis, 59.6% identified with subtype B and 48.4% in a cluster. Risk factors for clustering included Danish origin (odds ratio (OR): 2.95; 95% confidence interval (CI): 2.21-3.96), non-LP (OR: 1.44; 95% CI: 1.12-1.86), and men who have sex with men (MSM). Increasing age and non-B subtype infection decreased risk (OR: 0.69; 95% CI: 0.50-0.94). Risk for late presentation was lower for active clusters (OR: 0.60; 95% CI: 0.44-0.82) and Danish origin (OR: 0.43; 95% CI: 0.27-0.67). Non-Danish MSM had a lower risk than non-Danish heterosexuals (OR: 0.34; 95% CI: 0.21-0.55).ConclusionHIV-1 transmission in Denmark is driven by early diagnosed, young, subtype B infected MSM. These may benefit most from PrEP. Non-Danish heterosexual HIV-1 patients could benefit from improved communication to achieve earlier diagnosis and treatment.
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Affiliation(s)
- Maarten van Wijhe
- Department of Science and Environment, Roskilde University, Roskilde, Denmark.,Virus Research & Development Laboratory, Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Thea K Fischer
- Department of Research, University hospital of Nordsjælland, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannik Fonager
- Virus Research & Development Laboratory, Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
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Munck HNM, Qvist T, Helleberg M, Kaye PS, Pichon F, Cowan S. At-Risk Groups of Men Who Have Sex With Men Can Be Reached Through Community-Based HIV Testing in Denmark. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:439-449. [PMID: 34369829 DOI: 10.1521/aeap.2021.33.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study evaluates whether the community-based HIV testing clinic Checkpoint could reach at-risk groups of men who have sex with men (MSM) and link patients to care. A prospective observational study of all Checkpoint visits during 2013-2016 and a retrospective registry study of all MSM diagnosed with HIV in Denmark during the same period were conducted. One percent of the 9,074 tests in Checkpoint were HIV-positive, accounting for 19% of all new HIV diagnoses among MSM in Denmark. Checkpoint testers reported frequent condomless anal sex. Two percent of migrant Checkpoint testers were HIV-positive compared to 1 % among Danish MSM. HIV-positive MSM identified through Checkpoint were significantly younger, more of them were migrant, and a smaller proportion were late testers compared to those testing through the conventional health care system. Checkpoint reaches at-risk populations of MSM and links patients successfully to care.
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Affiliation(s)
| | - Tavs Qvist
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Susan Cowan
- Department of Sexually Transmitted Infections and Blood-Borne Viruses, Statens Serum Institut, Copenhagen, Denmark
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Rava M, Bisbal O, Domínguez-Domínguez L, Aleman MR, Rivero M, Antela A, Estrada V, Ribera E, Muñoz A, Iribarren JA, Moreno S, Rubio R, Jarrín I. Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment. AIDS 2021; 35:1283-1293. [PMID: 33813554 DOI: 10.1097/qad.0000000000002891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to examine the impact of late presentation (CD4+ cell count <350 cells/μl or an AIDS-defining event) on effectiveness and safety of initial antiretroviral therapy (ART) and to evaluate whether treatment response depends on first-line ART regimen in late presenters. DESIGN ART-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018. METHODS We used multivariable models to assess differences in viral suppression (viral load <50 copies/ml), immunological response (change in CD4+ cell count, CD4% (>29%) and CD4/CD8 normalization (>0.4 and >1) multiple T-cell marker recovery (MTMR): CD4+ cell count more than 500 cells/μl and CD4% >29% and CD4/CD8 >1), and treatment discontinuation due to adverse events (TDAE) at 48 weeks from ART initiation. RESULTS Out of 8002 participants, 48.7% were late presenters. Of them, 45.8% initiated ART with a NNRTI- (mostly TDF/FTC/EFV), 33.9% with a protease inhibitor (mostly TDF/FTC+boosted DRV) and 20.3% with an INI-based regimen (mostly ABC/3TC/DTG). At 48 weeks, late presenters had similar viral suppression, but worse immunological response, than non-late presenters with no difference on TDAE. Late presenters initiating with NNRTI-based regimens were more likely to achieve viral suppression than those starting with INI-based, due to the higher chance of achieving viral suppression observed with TDF/FTC/RPV compared to ABC/3TC/DTG. Initial treatment with NNRTI or protease inhibitor based showed similar immunological response than the INI-based regimens, which showed lower rates of TDAE than NNRTI- and protease inhibitor based regimens. CONCLUSION Despite safety and effectiveness of initial ART in terms of viral suppression, late presenters may not experience complete immunological response. In late presenters, effectiveness and safety depends on both the class and the specific first-line ART regimen.
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Affiliation(s)
- Marta Rava
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII)
| | - Otilia Bisbal
- Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid
| | | | - Ma Remedios Aleman
- Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands
| | - María Rivero
- Infectious Diseases Unit, Complejo Hospitalario de Navarra - IdiSNA, Pamplona
| | - Antonio Antela
- Hospital Clínico Universitario de Santiago, Santiago de Compostela
| | | | - Esteban Ribera
- Department of Infectious Diseases, Hospital Universitario Valle de Hebrón, Barcelona
| | - Adolfo Muñoz
- Research Unit on Digital Health. Health Institute Carlos III (ISCIII), Madrid
| | | | | | - Rafael Rubio
- Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid
| | - Inmaculada Jarrín
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII)
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Rava M, Domínguez-Domínguez L, Bisbal O, López-Cortés LF, Busca C, Antela A, González-Ruano P, Hernández C, Iribarren JA, Rubio R, Moreno S, Jarrín I. Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018. PLoS One 2021; 16:e0249864. [PMID: 33882093 PMCID: PMC8059864 DOI: 10.1371/journal.pone.0249864] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. METHODS CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). RESULTS 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). CONCLUSIONS LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
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Affiliation(s)
- Marta Rava
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
| | | | | | | | | | - Antonio Antela
- University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Cristina Hernández
- Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Josè-Antonio Iribarren
- Department of Infectious Diseases, University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Rafael Rubio
- 12 de Octubre University Hospital, Madrid, Spain
| | | | - Inmaculada Jarrín
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
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11
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Petersen A, Cowan SA, Nielsen J, Fischer TK, Fonager J. Characterisation of HIV-1 transmission clusters and drug-resistant mutations in Denmark, 2004 to 2016. Euro Surveill 2018; 23:1700633. [PMID: 30401010 PMCID: PMC6337072 DOI: 10.2807/1560-7917.es.2018.23.44.1700633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study describes the prevalence of human immunodeficiency virus (HIV) drug resistance mutations among 1,815 patients in Denmark from 2004 to 2016 and characterises transmission clusters. POL sequences were analysed for subtype, drug resistance mutations and phylogenetic relationship. The prevalence of surveillance drug resistance mutations (SDRM) was 6.7%, while the prevalence of drug resistance mutations (DRM) with a clinical impact was 12.3%. We identified 197 transmission clusters with 706 patients. Patients 40 years or older were less likely to be members of a transmission cluster and patients in transmission clusters were less likely to be infected abroad. The proportion of late presenters (LP) was lower in active compared with inactive clusters. Large active clusters consisted of more men who have sex with men (MSM), had members more frequently infected in Denmark and contained a significantly lower proportion of LP and significantly fewer patients with DRM than small active clusters. Subtyping demonstrated that the Danish HIV epidemic is gradually becoming more composed of non-B subtypes/circulating recombinant forms. This study shows that active HIV-1 transmission has become increasingly MSM-dominated and that the recent increase in SDRM and DRM prevalence is not associated with more sustained transmission within identified transmission networks or clusters.
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Affiliation(s)
- Andreas Petersen
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark,European Public Health Microbiology (EUPHEM) training programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Susan A Cowan
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Nielsen
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Thea K Fischer
- Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Jannik Fonager
- Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
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12
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Boender TS, Smit C, Sighem AV, Bezemer D, Ester CJ, Zaheri S, Wit FWNM, Reiss P. AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort: cohort profile. BMJ Open 2018; 8:e022516. [PMID: 30249631 PMCID: PMC6169757 DOI: 10.1136/bmjopen-2018-022516] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE In 1998, the AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort was established to demonstrate the lifesaving effectiveness of triple combination antiretroviral therapy, including HIV-protease inhibitors, that had recently been made available for clinical use. Subsequently, the HIV Monitoring Foundation was established by the Dutch Ministry of Health, Welfare and Sport to continue ATHENA as an open cohort in order to continue the registration and monitoring of all HIV-positive people as an integral part of HIV care in all 26 HIV treatment centres in the Netherlands. PARTICIPANTS To date, a total of 25 036 participants have been enrolled in the cohort, with 263 600 person-years of follow-up. As of 1 January 2017, 19 035 HIV-1-positive participants were known to be in care: 18 824 adults (81% men and 19% women) and 211 children (47% boys and 53% girls). The remaining 6001 participants had either died (46%), were lost to care (29%) or had moved abroad (25%). FINDINGS TO DATE Today, with over 20 years of follow-up, the ATHENA cohort has provided extensive knowledge on HIV treatment, comorbidities and coinfections and created insight into the transmission dynamics of the HIV epidemic. FUTURE PLANS ATHENA continues to enrol and monitor HIV positive people entering HIV care in the Netherlands. Future research will continue to provide tangible input into HIV care and prevention policies in the Netherlands and internationally.
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Affiliation(s)
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | | | | | - Sima Zaheri
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Ferdinand W N M Wit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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13
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Luma HN, Jua P, Donfack OT, Kamdem F, Ngouadjeu E, Mbatchou HB, Doualla MS, Mapoure YN. Late presentation to HIV/AIDS care at the Douala general hospital, Cameroon: its associated factors, and consequences. BMC Infect Dis 2018; 18:298. [PMID: 29970017 PMCID: PMC6029364 DOI: 10.1186/s12879-018-3204-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The introduction of anti-retroviral treatment (ART) has significantly reduced mortality and morbidity associated with HIV/AIDS. While treatment at early stages of the disease is related to a better prognosis, late presentation (LP) to care is harmful to the infected person, the society and is more costly. We aimed to describe late presentation to HIV care, its associated factors and consequences in patients followed up in a tertiary hospital in Cameroon. Methods We retrospectively assessed patients’ files between 1996 and 2014 at the Douala general hospital (DGH) HIV treatment centre. Late presentation (LP) to HIV care was defined as a CD4+ T cell count< 350 cells/mm3 or advanced clinical stages of the disease (WHO stages 3/4) at first presentation for care. We used logistic regression to study factors associated with late presentation and assessed occurrence of opportunistic infections and mortality at 3, 6 and 12 months after presentation to care. Results Of 1866 files studied, mean age was 40 (SD: 10) years, median CD4+ T cell count was 147 (IQR: 63–270) cells/mm3, 58.2% were at HIV clinical stages 3 and 4. The prevalence of late presentation to HIV care was 89.7% (95% CI: 88.2–91.0%) and remained above 80% from 1996 to 2014. Circumstances of diagnosis: prevention of mother to child transmission program/blood donation (OR = 0.16, 95% CI 0.10–0.29), having a positive partner (OR = 0.16, 95%CI = 0.10–0.26), and routine screening (OR = 0.13, 95%CI = 0.10–0.19) reduced the odds of presenting late compared to clinical suspicion. Students had lower odds of presenting late compared to people who had an employment (OR = 0.50, 95%CI = 0.26–0.98). Calendar time OR = 1.64, 95% CI = 1.08–2.48 for ≥2010 vs. < 2005) increased the odds of late presentation. Mortality and opportunistic infections prevalence remained significantly higher in late presenters at 3, 6 and 12 months than in early presenters. Conclusion Late presentation to HIV care is very high at the DGH and is related to poor outcome. More screening and sensitization campaigns should be carried out in the population to diagnose the disease at an earlier stage.
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Affiliation(s)
- Henry Namme Luma
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Paulia Jua
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Felicite Kamdem
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Eveline Ngouadjeu
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hugo Bertrand Mbatchou
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marie-Solange Doualla
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Yakouba Njankou Mapoure
- Douala General Hospital, P.0. Box 4856, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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14
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Verhofstede C, Fransen K, Van Den Heuvel A, Van Laethem K, Ruelle J, Vancutsem E, Stoffels K, Van den Wijngaert S, Delforge ML, Vaira D, Hebberecht L, Schauvliege M, Mortier V, Dauwe K, Callens S. Decision tree for accurate infection timing in individuals newly diagnosed with HIV-1 infection. BMC Infect Dis 2017; 17:738. [PMID: 29187159 PMCID: PMC5708102 DOI: 10.1186/s12879-017-2850-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
Background There is today no gold standard method to accurately define the time passed since infection at HIV diagnosis. Infection timing and incidence measurement is however essential to better monitor the dynamics of local epidemics and the effect of prevention initiatives. Methods Three methods for infection timing were evaluated using 237 serial samples from documented seroconversions and 566 cross sectional samples from newly diagnosed patients: identification of antibodies against the HIV p31 protein in INNO-LIA, SediaTM BED CEIA and SediaTM LAg-Avidity EIA. A multi-assay decision tree for infection timing was developed. Results Clear differences in recency window between BED CEIA, LAg-Avidity EIA and p31 antibody presence were observed with a switch from recent to long term infection a median of 169.5, 108.0 and 64.5 days after collection of the pre-seroconversion sample respectively. BED showed high reliability for identification of long term infections while LAg-Avidity is highly accurate for identification of recent infections. Using BED as initial assay to identify the long term infections and LAg-Avidity as a confirmatory assay for those classified as recent infection by BED, explores the strengths of both while reduces the workload. The short recency window of p31 antibodies allows to discriminate very early from early infections based on this marker. BED recent infection results not confirmed by LAg-Avidity are considered to reflect a period more distant from the infection time. False recency predictions in this group can be minimized by elimination of patients with a CD4 count of less than 100 cells/mm3 or without no p31 antibodies. For 566 cross sectional sample the outcome of the decision tree confirmed the infection timing based on the results of all 3 markers but reduced the overall cost from 13.2 USD to 5.2 USD per sample. Conclusions A step-wise multi assay decision tree allows accurate timing of the HIV infection at diagnosis at affordable effort and cost and can be an important new tool in studies analyzing the dynamics of local epidemics or the effects of prevention strategies.
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Affiliation(s)
- Chris Verhofstede
- Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
| | - Katrien Fransen
- HIV/STD Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annelies Van Den Heuvel
- HIV/STD Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristel Van Laethem
- Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven - University of Leuven, Leuven, Belgium.,Aids Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Jean Ruelle
- Aids Reference Laboratory, Medical Microbiology unit, Université Catholique de Louvain, Brussels, Belgium
| | - Ellen Vancutsem
- Aids Reference Laboratory, Vrije Universiteit Brussel VUB, Brussels, Belgium
| | - Karolien Stoffels
- Aids Reference Laboratory, Centre Hospitalier Universitaire St. Pierre, Brussels, Belgium
| | - Sigi Van den Wijngaert
- Aids Reference Laboratory, Centre Hospitalier Universitaire St. Pierre, Brussels, Belgium
| | | | - Dolores Vaira
- Aids Reference Laboratory, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laura Hebberecht
- Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Marlies Schauvliege
- Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Virginie Mortier
- Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Kenny Dauwe
- Aids Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Steven Callens
- Aids Reference Center and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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15
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16
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Raffetti E, Postorino MC, Castelli F, Casari S, Castelnuovo F, Maggiolo F, Di Filippo E, D'Avino A, Gori A, Ladisa N, Di Pietro M, Sighinolfi L, Zacchi F, Torti C. The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort. BMC Public Health 2016; 16:878. [PMID: 27557878 PMCID: PMC4997689 DOI: 10.1186/s12889-016-3477-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. METHODS All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. RESULTS 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. CONCLUSION Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.
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Affiliation(s)
- Elena Raffetti
- Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Maria Concetta Postorino
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy
| | - Francesco Castelli
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Salvatore Casari
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | - Franco Maggiolo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Elisa Di Filippo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Alessandro D'Avino
- Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, Ospedale "S. Gerardo", Monza, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Diseases, University of Bari, Bari, Italy
| | - Massimo Di Pietro
- Clinic of Infectious Diseases, "S. M. Annunziata" Hospital, Florence, Italy
| | - Laura Sighinolfi
- Clinic of Infectious Diseases, "S. Anna" Hospital, Ferrara, Italy
| | - Fabio Zacchi
- Clinic of Infectious Diseases, Istituti Ospitalieri Cremona, Cremona, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy.
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17
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Mocroft A, Lundgren J, Antinori A, Monforte AD, Brännström J, Bonnet F, Brockmeyer N, Casabona J, Castagna A, Costagliola D, De Wit S, Fätkenheuer G, Furrer H, Jadand C, Johnson A, Lazanas M, Leport C, Moreno S, Mussini C, Obel N, Post F, Reiss P, Sabin C, Skaletz-Rorowski A, Suarez-Loano I, Torti C, Warszawski J, Wittkop L, Zangerle R, Chene G, Raben D, Kirk O. Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013. ACTA ACUST UNITED AC 2016; 20:30070. [PMID: 26624933 DOI: 10.2807/1560-7917.es.2015.20.47.30070] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/18/2015] [Indexed: 11/20/2022]
Abstract
Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010-2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrollment) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count < 350/mm(3) or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. A total of 30,454 people were included. The median CD4 count at presentation was 368/mm(3) (interquartile range (IQR) 193-555/mm(3)), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02-1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85-0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.
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Abstract
PURPOSE OF REVIEW Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) as a result of ongoing quality improvement measures, neonatal sepsis remains a frequent and devastating problem among hospitalized preterm neonates. Despite multiple attempts to address this unmet need, there have been minimal advances in clinical management, outcomes, and accuracy of diagnostic testing options over the last 3 decades. One strong contributor to a lack of medical progress is a variable case definition of disease. The inability to agree on a precise definition greatly reduces the likelihood of aligning findings from epidemiologists, clinicians, and researchers, which, in turn, severely hinders progress toward improving outcomes. RECENT FINDINGS Pediatric consensus definitions for sepsis are not accurate in term infants and are not appropriate for preterm infants. In contrast to the defined multistage criteria for other devastating diseases encountered in the NICU (e.g., bronchopulmonary dysplasia), there is significant variability in the criteria used by investigators to substantiate the diagnosis of neonatal sepsis. SUMMARY The lack of an accepted consensus definition for neonatal sepsis impedes our efforts toward improved diagnostic and prognostic options, and accurate outcomes information for this vulnerable population.
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Van Beckhoven D, Florence E, Ruelle J, Deblonde J, Verhofstede C, Callens S, Vancutsem E, Lacor P, Demeester R, Goffard JC, Sasse A. Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants. BMC Infect Dis 2015; 15:496. [PMID: 26530500 PMCID: PMC4631021 DOI: 10.1186/s12879-015-1230-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/19/2015] [Indexed: 01/06/2023] Open
Abstract
Background The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors. Methods Data on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied. Results Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression. Conclusions The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - E Florence
- Department of Clinical Sciences, Instituut Tropische Geneeskunde, Antwerp, Belgium.
| | - J Ruelle
- Institute of Experimental and Clinical Research (IREC), Unit of Medical Microbiology (MBLG), Université Catholique de Louvain, Brussels, Belgium.
| | - J Deblonde
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - C Verhofstede
- AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
| | - S Callens
- Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium.
| | - E Vancutsem
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - R Demeester
- Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium.
| | - J-C Goffard
- Service of Internal Medicine, Hôpital Erasme, Brussels, Belgium.
| | - A Sasse
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
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