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Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study. J Korean Med Sci 2020; 35:e355. [PMID: 33107229 PMCID: PMC7590652 DOI: 10.3346/jkms.2020.35.e355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. METHODS A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan-Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. RESULTS Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate (P = 0.228), causes of death (P = 0.771), or survival analysis (P = 0.089) between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. CONCLUSION Being diagnosed with CD4 < 200 cells/mm³ at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm³ group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin Woo Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyun Ha Chang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sohyun Bae
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Bajpai R, Chaturvedi HK, Car J. How varying CD4 criteria for treatment initiation was associated with mortality of HIV-patients? A retrospective analysis of electronic health records from Andhra Pradesh, India. J Glob Health 2020; 10:010408. [PMID: 32257156 PMCID: PMC7125424 DOI: 10.7189/jogh.10.010408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background HIV treatment and care services were scaled up in 2007 in India with objective to increase HIV-care coverage. CD4 count based criteria was mainly used for treatment initiation with increasing threshold in later years. Therefore, this paper aimed to evaluate the survival by varying CD4 criteria for antiretroviral treatment (ART) initiation among of HIV-positive patients, and independent factors associated with the mortality. Methods This retrospective cohort study included 127 949 HIV-positive patients aged ≥15 years, who initiated ART between 2007 and 2013 in Andhra Pradesh state, India. The patient’s demographic and clinical characteristics were extracted from the patient’s health records from electronic Computerized Management Information System Software (CMIS). Incidence of mortality/100 person-years was calculated for CD4 and treatment initiation categories. Kaplan-Meier and multivariable Cox-regression analyses were used to explore the association. Results Median CD4 count was 172 (inter-quartile range (IQR) = 102-240) at the time of treatment initiation, and 19.3% of them had ≤ 100 CD4 count. Incidence of mortality for the period 2007-08 (CD4 ≤ 200 cells/mm3) was 8.5/100 person-years compared to 6.4/100 person-years at risk for the period 2012 onwards (CD4 ≤ 350 cells/mm3). Earlier thresholds for treatment initiation showed higher risk of mortality (2007-08 (CD4 ≤ 200 cells/mm3), adjusted hazard ratio (HR): 1.86, 95% confidence interval (CI): 1.68-2.07; 2009-11 (CD4 ≤ 250 cells/mm3), HR = 1.67, 95% CI = 1.51-1.85) compared to 2012 onwards (CD4 ≤ 350 cells/mm3) criteria for treatment initiation. Conclusions Increasing CD4 threshold for treatment initiation over time was independently associated with lower risk of mortality. More efforts are required to detect and treat early, monitoring of follow-ups, promote health education to improve ART adherence, and provide supportive environment that encourages HIV-infected patients to disclose their HIV status in confidence.
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Affiliation(s)
- Ram Bajpai
- School of Primary Community and Social Care, Keele University, Newcastle-Under-Lyme, Staffordshire, UK.,National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Himanshu K Chaturvedi
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Bijker R, Kiertiburanakul S, Kumarasamy N, Pujari S, Sun LP, Ng OT, Lee MP, Choi JY, Nguyen KV, Chan YJ, Merati TP, Cuong DD, Ross J, Jiamsakul A. Survival after long-term ART exposure: findings from an Asian patient population retained in care beyond 5 years on ART. Antivir Ther 2020; 25:131-142. [PMID: 32369040 DOI: 10.3851/imp3358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study investigated survival in people living with HIV being followed-up from 5 and 10 years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort. METHODS We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond 5 and 10 years on ART were analysed using competing risk regression with time-updated variables. RESULTS Of 13,495 patients retained after 5 years on ART, 279 subsequently died (0.56/100 person-years). Increased mortality was associated with age >50 years (sub-hazard ratio [sHR] 2.24, 95% CI 1.58, 3.15, compared with ≤40 years), HIV exposure through injecting drug use (sHR 2.17, 95% CI 1.32, 3.56), HIV viral load ≥1,000 copies/ml: sHR 1.52, 95% CI 1.05, 2.21, compared with <400), regimen (second-line regimen: sHR 2.11, 95% CI 1.52, 2.94, and third-line regimen: sHR 2.82, 95% CI 2.00, 3.98, compared with first-line regimen), HBV coinfection (sHR 2.23, 95% CI 1.49, 3.33), fasting plasma glucose ≥126 mg/dl (sHR 1.98, 95% CI 1.22, 3.21, compared with <100 mg/dl) and estimated glomerular filtration rate <60 ml/min/1.73 m2 (sHR 2.57, 95% CI 1.56, 4.22). Decreased mortality was associated with transmission through male-to-male sexual contact (sHR 0.44, 95% CI 0.22, 0.88, compared with heterosexual transmission) and higher CD4+ T-cell count (200-349 cells/µl: sHR 0.27, 95% CI 0.20, 0.38, 350-499 cells/µl: sHR 0.10, 95% CI 0.07, 0.16 and ≥500 cells/µl: sHR 0.09, 95% CI 0.06, 0.13, compared with <200 cells/µl). Results after 10 years were similar, but most associations were weaker due to limited power. CONCLUSIONS Next to preventing ART failure, HIV programmes should carefully monitor and treat comorbidities, including hepatitis, kidney disease and diabetes, to optimize survival after long-term ART exposure.
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Affiliation(s)
- Rimke Bijker
- The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | | | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Ly P Sun
- National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia
| | - Oon T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Man P Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Jun Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kinh V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Yu J Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tuti P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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Akbari M, Fararouei M, Haghdoost AA, Gouya MM, Kazerooni PA. Survival and associated factors among people living with HIV/AIDS: A 30-year national survey in Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:5. [PMID: 30815018 PMCID: PMC6383342 DOI: 10.4103/jrms.jrms_630_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/08/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
Background: The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran. Materials and Methods: The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis. Results: Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher. Conclusion: The survival in studied patients increased in recent time periods, and ART reduced AIDS-related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.
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Affiliation(s)
- Mojtaba Akbari
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Haghdoost
- Department of Epidemiology and Biostatistics, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Mahdi Gouya
- National Communicable Disease Control Centre, Ministry of Health and Medical Education, Tehran, Iran
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Momenyan S, Kavousi A, Poorolajal J, Momenyan N. Spatial inequalities and predictors of HIV/AIDS mortality risk in Hamadan, Iran: a retrospective cohort study. Epidemiol Health 2018; 40:e2018038. [PMID: 30081619 PMCID: PMC6232660 DOI: 10.4178/epih.e2018038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/05/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Understanding the geographic variation of HIV/AIDS mortality risk and human immunodeficiency virus (HIV) infection could help identify high-burden areas. The aim of our study was to evaluate the effects of predictors of the time interval between HIV diagnosis to death, while accounting for spatial correlations across counties, and to assess patterns of spatial inequalities in the risk of HIV/AIDS mortality in Hamadan Province, Iran. METHODS This retrospective study was conducted on 585 patients. The outcome in this study was the time period between the date of HIV/AIDS diagnosis and the date of death. A Weibull regression model with spatial random effects was used. RESULTS According to multivariate analysis, there were significant associations between age, tuberculosis co-infection, and marital status and the risk of death. In terms of spatial inequalities, a cluster of counties was identified with a somewhat higher death hazard in the north, northwest, northeast, and central regions. Additionally, a cluster with a somewhat lower hazard was identified in the south, southwest, southeast, and west regions. CONCLUSIONS The spatial pattern of HIV/AIDS death risk could reflect inequalities in access to antiretroviral therapy and public health services. Our results underscore the importance of attention to vulnerable groups in urban areas.
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Affiliation(s)
- Somayeh Momenyan
- Department of Biostatistics, Paramedical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kavousi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Narges Momenyan
- Department of Medical Informatics, Tarbiat Modares University, Tehran, Iran
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De La Mata NL, Ly PS, Ng OT, Nguyen KV, Merati TP, Pham TT, Lee MP, Choi JY, Sohn AH, Law MG, Kumarasamy N. Trends in CD4 cell count response to first-line antiretroviral treatment in HIV-positive patients from Asia, 2003-2013: TREAT Asia HIV Observational Database Low Intensity Transfer. Int J STD AIDS 2017. [PMID: 28632481 DOI: 10.1177/0956462417699538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antiretroviral treatment (ART) guidelines have changed over the past decade, recommending earlier initiation and more tolerable regimens. The study objective was to examine the CD4 response to ART, depending on the year of ART initiation, in HIV-positive patients in the Asia-Pacific. We included HIV-positive adult patients who initiated ART between 2003 and 2013 in our regional cohort from eight urban referral centres in seven countries within Asia. We used mixed-effects linear regression models to evaluate differences in CD4 response by year of ART initiation during 36 months of follow-up, adjusted a priori for other covariates. Overall, 16,962 patients were included. Patients initiating in 2006-9 and 2010-13 had an estimated mean CD4 cell count increase of 8 and 15 cells/µl, respectively, at any given time during the 36-month follow-up, compared to those in 2003-5. The median CD4 cell count at ART initiation also increased from 96 cells/µl in 2003-5 to 173 cells/µl in 2010-13. Our results suggest that the CD4 response to ART is modestly higher for those initiating ART in more recent years. Moreover, fewer patients are presenting with lower absolute CD4 cell counts over time. This is likely to reduce their risk of opportunistic infections and future non-AIDS defining cancers.
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Affiliation(s)
| | - Penh S Ly
- 2 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Oon T Ng
- 3 Tan Tock Seng Hospital, Singapore, Singapore
| | - Kinh V Nguyen
- 4 National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Tuti P Merati
- 5 Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - Man P Lee
- 7 Queen Elizabeth Hospital, Hong Kong, China
| | - Jun Y Choi
- 8 Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Annette H Sohn
- 9 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew G Law
- 1 The Kirby Institute, UNSW Sydney, Sydney, Australia
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Bajpai R, Chaturvedi H, Jayaseelan L, Harvey P, Seguy N, Chavan L, Raj P, Pandey A. Effects of Antiretroviral Therapy on the Survival of Human Immunodeficiency Virus-positive Adult Patients in Andhra Pradesh, India: A Retrospective Cohort Study, 2007-2013. J Prev Med Public Health 2016; 49:394-405. [PMID: 27951632 PMCID: PMC5160137 DOI: 10.3961/jpmph.16.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/28/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mm3 vs. >350 cells/mm3), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.
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Affiliation(s)
- Ram Bajpai
- Department of Community Medicine, Army College of Medical Sciences, New Delhi, India
| | | | | | - Pauline Harvey
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, New Delhi, India
| | - Nicole Seguy
- World Health Organization Country Office for India, New Delhi, India
| | - Laxmikant Chavan
- World Health Organization Country Office for India, New Delhi, India
| | | | - Arvind Pandey
- National Institute of Medical Statistics, New Delhi, India
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Poorolajal J, Hooshmand E, Mahjub H, Esmailnasab N, Jenabi E. Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis. Public Health 2016; 139:3-12. [PMID: 27349729 DOI: 10.1016/j.puhe.2016.05.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/19/2016] [Accepted: 05/11/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND The life expectancy of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) reported by several epidemiological studies is inconsistent. This meta-analysis was conducted to estimate the survival rate from HIV diagnosis to AIDS onset and from AIDS onset to death. METHODS The electronic databases PubMed, Web of Science and Scopus were searched to February 2016. In addition, the reference lists of included studies were checked to identify further references, and the database of the International AIDS Society was also searched. Cohort studies addressing the survival rate in patients diagnosed with HIV/AIDS were included in this meta-analysis. The outcomes of interest were the survival rate of patients diagnosed with HIV progressing to AIDS, and the survival rate of patients with AIDS dying from AIDS-related causes with or without highly active antiretroviral therapy (HAART). The survival rate (P) was estimated with 95% confidence intervals based on random-effects models. RESULTS In total, 27,862 references were identified, and 57 studies involving 294,662 participants were included in this meta-analysis. Two, 4-, 6-, 8-, 10- and 12-year survival probabilities of progression from HIV diagnosis to AIDS onset were estimated to be 82%, 72%, 64%, 57%, 26% and 19%, respectively. Two, 4-, 6-, 8- and 10-year survival probabilities of progression from AIDS onset to AIDS-related death in patients who received HAART were estimated to be 87%, 86%, 78%, 78%, and 61%, respectively, and 2-, 4- and 6-year survival probabilities of progression from AIDS onset to AIDS-related death in patients who did not receive HAART were estimated to be 48%, 26% and 18%, respectively. Evidence of considerable heterogeneity was found. The majority of the studies had a moderate to high risk of bias. CONCLUSION The majority of HIV-positive patients progress to AIDS within the first decade of diagnosis. Most patients who receive HAART will survive for >10 years after the onset of AIDS, whereas the majority of the patients who do not receive HAART die within 2 years of the onset of AIDS.
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Affiliation(s)
- J Poorolajal
- Research Centre for Health Sciences, Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - E Hooshmand
- Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - H Mahjub
- Modelling of Noncommunicable Diseases Research Centre, Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - N Esmailnasab
- Kurdistan Research Centre for Social Determinants of Health, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - E Jenabi
- Department of Midwifery, Toyserkan Branch, Islamic Azad University, Toyserkan, Iran
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Javalkar P, Prakash R, Isac S, Washington R, Halli SS. An Estimation of Mortality Risks among People Living with HIV in Karnataka State, India: Learnings from an Intensive HIV/AIDS Care and Support Programme. PLoS One 2016; 11:e0156611. [PMID: 27253974 PMCID: PMC4890789 DOI: 10.1371/journal.pone.0156611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/17/2016] [Indexed: 12/30/2022] Open
Abstract
Background In Indian context, limited attempts have been made to estimate the mortality risks among people living with HIV (PLHIV). We estimated the rates of mortality among PLHIV covered under an integrated HIV-prevention cum care and support programme implemented in Karnataka state, India, and attempted to identify the key programme components associated with the higher likelihood of their survival. Methods Retrospective programme data of 55,801 PLHIV registered with the Samastha programme implemented in Karnataka state during 2006–11 was used. Kaplan-Meier survival methods were used to estimate the ten years expected survival probabilities and Cox-proportional hazard model was used to examine the factors associated with risk of mortality among PLHIV. We also calculated mortality rates (per 1000 person-year) across selected demographic and clinical parameters. Results Of the total PLHIV registered with the programme, about nine percent died within the 5-years of programme period with an overall death rate of 38 per 1000 person-years. The mortality rate was higher among males, aged 18 and above, among illiterates, and those residing in rural areas. While the presence of co-infections such as Tuberculosis leads to higher mortality rate, adherence to ART was significantly associated with reduction in overall death rate. Cox proportional hazard model revealed that increase in CD4 cell counts and exposure to intensive care and support programme for at least two years can bring significant reduction in risk of death among PLHIV [(hazard ratio: 0.234; CI: 0.211–0.260) & (hazard ratio: 0.062; CI: 0.054–0.071), respectively] even after adjusting the effect of other socio-demographic, economic and health related confounders. Conclusion Study confirms that while residing in rural areas and presence of co-infection significantly increases the mortality risk among PLHIV, adherence to ART and improvement in CD4 counts led to significant reduction in their mortality risk. Longer exposure to the intervention contributed significantly to reduce mortality among PLHIV.
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Affiliation(s)
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Reynold Washington
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
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Obiri-Yeboah D, Amoako-Sakyi D, Baidoo I, Adu-Oppong A, Rheinländer T. The 'Fears' of Disclosing HIV Status to Sexual Partners: A Mixed Methods Study in a Counseling Setting in Ghana. AIDS Behav 2016; 20:126-36. [PMID: 25711298 DOI: 10.1007/s10461-015-1022-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Encouraging disclosure within a trusting and supportive environment is imperative in dealing with HIV/AIDS related stigma. However, disclosure rates and the factors that influence it are vaguely understood in African societies. This study aimed at determining the disclosure rate and factors that influence disclosure in Cape Coast, Ghana. In-depth interviews of 15 peer educators and a survey of 510 PLHIV were used in a mixed methods study design. Majority of the study participants (78.6 %) had disclosed their HIV positive status to their sexual partners. Although peer educators in this study portrayed the overall outcome of disclosure to be negative, 84.0 % of disclosers were accepted by their partners without negative consequences after disclosure. This study suggests that the existing support services ill prepares newly diagnosed HIV positive clients and hampers disclosure initiatives. Providing comprehensive support services and re-training peer educators may be crucial in creating a safe disclosure environment in Ghana.
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Affiliation(s)
- D Obiri-Yeboah
- Department of Microbiology, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast, Ghana.
| | - D Amoako-Sakyi
- Department of Microbiology, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - I Baidoo
- ART Center, Cape Coast Teaching Hospital, P.O. Box CT 1363, Cape Coast, Ghana
| | - A Adu-Oppong
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - T Rheinländer
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Suguimoto SP, Techasrivichien T, Musumari PM, El-saaidi C, Lukhele BW, Ono-Kihara M, Kihara M. Changing patterns of HIV epidemic in 30 years in East Asia. Curr HIV/AIDS Rep 2015; 11:134-45. [PMID: 24664878 DOI: 10.1007/s11904-014-0201-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.
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Affiliation(s)
- S Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan,
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12
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Kim SB, Yoon M, Ku NS, Kim MH, Song JE, Ahn JY, Jeong SJ, Kim C, Kwon HD, Lee J, Smith DM, Choi JY. Mathematical modeling of HIV prevention measures including pre-exposure prophylaxis on HIV incidence in South Korea. PLoS One 2014; 9:e90080. [PMID: 24662776 PMCID: PMC3963840 DOI: 10.1371/journal.pone.0090080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Multiple prevention measures have the possibility of impacting HIV incidence in South Korea, including early diagnosis, early treatment, and pre-exposure prophylaxis (PrEP). We investigated how each of these interventions could impact the local HIV epidemic, especially among men who have sex with men (MSM), who have become the major risk group in South Korea. A mathematical model was used to estimate the effects of each these interventions on the HIV epidemic in South Korea over the next 40 years, as compared to the current situation. Methods We constructed a mathematical model of HIV infection among MSM in South Korea, dividing the MSM population into seven groups, and simulated the effects of early antiretroviral therapy (ART), early diagnosis, PrEP, and combination interventions on the incidence and prevalence of HIV infection, as compared to the current situation that would be expected without any new prevention measures. Results Overall, the model suggested that the most effective prevention measure would be PrEP. Even though PrEP effectiveness could be lessened by increased unsafe sex behavior, PrEP use was still more beneficial than the current situation. In the model, early diagnosis of HIV infection was also effectively decreased HIV incidence. However, early ART did not show considerable effectiveness. As expected, it would be most effective if all interventions (PrEP, early diagnosis and early treatment) were implemented together. Conclusions This model suggests that PrEP and early diagnosis could be a very effective way to reduce HIV incidence in South Korea among MSM.
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Affiliation(s)
- Sun Bean Kim
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoungho Yoon
- Department of Mathematics, Yonsei University, Seoul, South Korea
| | - Nam Su Ku
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Hyung Kim
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Je Eun Song
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Ahn
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Jeong
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee-Dae Kwon
- Department of Mathematics, Inha University, Incheon, South Korea
| | - Jeehyun Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Davey M. Smith
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Jun Yong Choi
- Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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13
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Phuphuakrat A, Kiertiburanakul S, Sungkanuparph S. Current status of HIV treatment in Asia and the Pacific region. Sex Health 2014; 11:119-25. [PMID: 24433878 DOI: 10.1071/sh13045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 10/28/2013] [Indexed: 11/23/2022]
Abstract
Asia and the Pacific represent a diverse group of nations facing HIV epidemic profiles of differing severity. Compared to other parts of the world, the burden of HIV disease is high in this region because of its large populations. At the end of 2011, 5million people were living with HIV in Asia and the Pacific. This accounted for 15% of people living with HIV worldwide. The prevalence of people living with HIV, as well as access to HIV treatment and care, varies widely between countries. Differences between high-income economies and the rest of the continent are remarkable. Many high-income countries provide antiretroviral therapy (ART) to their citizens. Middle- and low-income countries have rapid ART scale-up and are dependent on international funding. This may compromise the sustainability of ART availability. In addition, lack of access to second- and third-line therapy remains a problem in many countries. The global goal of achieving universal access to ART by 2015 requires mainly low- and middle-income countries to be targeted. Regional policy should be developed in order to identify new infections in key populations, to start earlier treatment, to retain patients in care and to maintain funding.
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Affiliation(s)
- Angsana Phuphuakrat
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sasisopin Kiertiburanakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Somnuek Sungkanuparph
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Lee SH, Kim KH, Lee SG, Cho H, Chen DH, Chung JS, Kwak IS, Cho GJ. Causes of death and risk factors for mortality among HIV-infected patients receiving antiretroviral therapy in Korea. J Korean Med Sci 2013; 28:990-7. [PMID: 23853480 PMCID: PMC3708097 DOI: 10.3346/jkms.2013.28.7.990] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 05/22/2013] [Indexed: 11/20/2022] Open
Abstract
A retrospective study was conducted to determine the mortality, causes and risk factors for death among HIV-infected patients receiving antiretroviral therapy (ART) in Korea. The outcomes were determined by time periods, during the first year of ART and during 1-5 yr after ART initiation, respectively. Patients lost to follow-up were traced to ascertain survival status. Among 327 patients initiating ART during 1998-2006, 68 patients (20.8%) died during 5-yr follow-up periods. Mortality rate per 100 person-years was 8.69 (95% confidence interval, 5.68-12.73) during the first year of ART, which was higher than 4.13 (95% confidence interval, 2.98-5.59) during 1-5 yr after ART. Tuberculosis was the most common cause of death in both periods (30.8% within the first year of ART and 16.7% during 1-5 yr after ART). During the first year of ART, clinical category B and C at ART initiation, and underlying malignancy were significant risk factors for mortality. Between 1 and 5 yr after ART initiation, CD4 cell count ≤ 50 cells/µL at ART initiation, hepatitis B virus co-infection, and visit constancy ≤ 50% were significant risk factors for death. This suggests that different strategies to reduce mortality according to the time period after ART initiation are needed.
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Affiliation(s)
- Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
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Lee SH, Kim KH, Lee SG, Chen DH, Jung DS, Moon CS, Park JY, Chung JS, Kwak IS, Cho GJ. Trends of mortality and cause of death among HIV-infected patients in Korea, 1990-2011. J Korean Med Sci 2013; 28:67-73. [PMID: 23341714 PMCID: PMC3546107 DOI: 10.3346/jkms.2013.28.1.67] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/15/2012] [Indexed: 11/20/2022] Open
Abstract
Although a decrease in acquired immunodeficiency syndrome (AIDS)-related mortality has been documented in highly active antiretroviral therapy (HAART) era, there are no published data comparing specific causes of death between pre-HAART and HAART era in Korea. Mortality and cause of death were analyzed in three treatment periods; pre-HAART (1990-1997), early-HAART (1998-2001), and late-HAART period (2002-2011). The patients were retrospectively classified according to the treatment period in which they were recruited. Although mortality rate per 100 person-year declined from 8.7 in pre-HAART to 4.9 in late-HAART period, the proportion of deaths within 3 months of initial visit to study hospital significantly increased from 15.9% in pre-HAART to 55.1% in late-HAART period (P < 0.001). Overall, 59% of deaths were attributable to AIDS-related conditions, and Pneumocystis pneumonia (PCP) was the most common cause of death (20.3%). The proportion of PCP as cause of death significantly increased from 8.7% in pre-HAART to 31.8% in late-HAART period (P < 0.001). Despite of significant improvement of survival, there was still a high risk of early death in patients presenting in HAART era, mainly due to late human immunodeficiency virus (HIV) diagnosis and late presentation to care.
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Affiliation(s)
- Sun Hee Lee
- Deparment of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
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Choe PG, Park WB, Song JS, Kim NH, Park JY, Song KH, Park SW, Kim HB, Kim NJ, Oh MD. Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening. J Infect 2011; 63:60-5. [PMID: 21621848 DOI: 10.1016/j.jinf.2011.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/29/2011] [Accepted: 05/01/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the risk factors for late presentation in the Republic of Korea, where massive mandatory screening for HIV infection was conducted by the government until the late 1990s. METHODS Data over the period 1987-2008 were analyzed from HIV patients for whom records of CD4 cell counts within 3 months of HIV diagnosis were available. Using multivariate logistic regression analysis including demographic and clinical variables, we examined factors associated with late presentation, defined as having a CD4 cell count of less than 200 cells/mm(3) at the time of diagnosis. RESULTS Of a total of 994 patients with a new diagnosis of HIV infection, 405 (41%) were late presenters. As the proportion of patients diagnosed by mandatory screening decreased over time (31% in 1987-1998 versus 8% in 1999-2008, P < 0.001), the proportion of late presenters increased (31% in 1987-1998 versus 43% in 1999-2008, P = 0.007). The independent risk factors for late presentation were older age (adjusted odds ratio [aOR], per increase of 10 years, 1.31; 95% confidence interval [CI], 1.15-1.49; P < 0.001), male sex (aOR, 1.74; 95% CI, 1.03-2.95; P = 0.040), negativity for VDRL (aOR, 1.58; 95% CI, 1.16-2.14; P = 0.003), and diagnosis after 1999 (aOR, 1.64; 95% CI, 1.05-2.56; P = 0.031). CONCLUSIONS Older age, male sex, negativity for VDRL, and diagnosis after 1999, were associated with late presentation, and the proportion of late presenters increased after the mandatory testing policy was abolished.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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Lee JH, Kim GJ, Choi BS, Hong KJ, Heo MK, Kim SS, Kee MK. Increasing late diagnosis in HIV infection in South Korea: 2000-2007. BMC Public Health 2010; 10:411. [PMID: 20624319 PMCID: PMC2912814 DOI: 10.1186/1471-2458-10-411] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 07/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of Koreans diagnosed with human immunodeficiency virus (HIV) infections is increasing annually; however, CD4+ T-cell counts at diagnosis have decreased. The purpose of the present study was to identify clinical and epidemiologic associations with low CD4+ T-cell counts at the time of HIV diagnosis in a Korean population. METHODS Data from 2,299 HIV-infected individuals with initial CD4+ T-cell counts measured within 6 months of HIV diagnosis and reason for HIV testing were recorded and measured from 2000 to 2007. Data were selected from the database of the Korea Centers for Disease Control and Prevention. Late diagnosis was defined by CD4+ T-cell counts <200 cells/mm3. Reasons for HIV testing were analyzed using logistic regression including epidemiologic variables. RESULTS A total of 858 individuals (37.3%) were included in the late diagnosis group. Individuals with a late diagnosis were older, exposed through heterosexual contact, and demonstrated clinical manifestations of acquired immunodeficiency syndrome (AIDS). The primary reason for HIV testing was a routine health check-up (41%) followed by clinical manifestations (31%) of AIDS. The proportion of individuals with a late diagnosis was higher in individuals tested due to clinical symptoms in public health centers (adjusted odds ratio [AOR], 17.3; 95% CI, 1.7-175) and hospitals (AOR, 4.9; 95% CI, 3.4-7.2) compared to general health check-up. Late diagnosis annually increased in individuals diagnosed by voluntary testing both in public health centers (PHCs, P = 0.017) and in hospitals (P = 0.063). Routine testing due to risky behaviors resulted in earlier detection than testing secondary to health check-ups, although this difference was not statistically significant (AOR, 0.7; P = 0.187). Individuals identified as part of hospital health check-ups more frequently had a late diagnosis (P = 0.001) CONCLUSIONS HIV infection was primarily detected by voluntary testing with identification in PHCs and by testing due to clinical symptoms in hospitals. However, early detection was not influenced by either voluntary testing or general health check-up. It is important to encourage voluntary testing for early detection to decrease the prevalence of HIV infection and AIDS progression.
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Affiliation(s)
- Jin-Hee Lee
- Division of AIDS, Korea Centers for Disease Control and Prevention, Seoul, Korea
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