1
|
Xu Z, Shen Q, Wang D, Dong Z, Han W, Tian R, Zhou K, Ya X, Hu H. Real-world data in late presentation of HIV infection in Suzhou, China: Results from four consecutive cross-sectional surveys, 2017-2020. Front Public Health 2023; 11:1084840. [PMID: 36895684 PMCID: PMC9989277 DOI: 10.3389/fpubh.2023.1084840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
Objectives This study aimed to examine the real prevalence of late presentation of HIV infection and to identify factors associated with late HIV presentation among patients with newly diagnosed HIV/AIDS in Suzhou, China. Methods Patients with newly diagnosed HIV/AIDS who registered in national AIDS surveillance system from 2017 to 2020 were included in this study. Late presentation (LP) of HIV infection was defined as HIV diagnosis with a CD4 count < 350 cells/μL or an AIDS-defining event. Multivariable logistic regression analyses were used to identify factors associated with LP. Results A total of 2,300 patients were enrolled. 1,325 were classified as late presenters, showing a high percentage of 57.6% (95% CI: 54.5-60.7%) and a rise (P = 0.004) over the four-year period. Patients with newly diagnosed HIV/AIDS who were older than 24 years of age (aOR = 1.549, P = 0.001 for 25-39 years; aOR = 2.389, P < 0.001 for 40 years and older), were Suzhou registered residents (aOR = 1.259, P = 0.026), and were from inpatient and outpatient (aOR = 1.935, P < 0.001) were more likely to be late presentation. Conclusions This study showed a high percentage and a rise of late presentation of HIV infection among patients with newly diagnosed HIV/AIDS in Suzhou, China, which is a challenge for future prevention and control of AIDS. Targeted measures should be urgently implemented to reduce late HIV diagnosis.
Collapse
Affiliation(s)
- Zhihui Xu
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Qiang Shen
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Di Wang
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Zefeng Dong
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Weining Han
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Runfang Tian
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Kai Zhou
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Xuerong Ya
- Suzhou Municipal Center for Disease Control and Prevention, Suzhou, China
| | - Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| |
Collapse
|
2
|
Health-Related Quality of Life, Pain and Sleep in Patients with HIV Depending on the Clinical Situation: A Cross-Sectional Pilot Study. Trop Med Infect Dis 2022; 7:tropicalmed7120409. [PMID: 36548664 PMCID: PMC9788612 DOI: 10.3390/tropicalmed7120409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction: Health-related quality of life (HRQL), pain and sleep have been described as relevant traits in patients with human immunodeficiency virus (HIV). The aim of this study is to describe and evaluate HRQL, pain and sleep and their interdependence in HIV-positive patients. Methods: A cross-sectional study on HIV-infected patients was conducted. A set of five different questionnaires was used: two questionnaires addressing HRQL (Short Form 36 [SF-36] Health Survey and Medical Outcomes Study Short Form 30 [MOS-SF 30]), one on pain (McGill Pain Questionnaire) and one on sleep (Pittsburgh Sleep Quality Index [PSQI]). We also collected the sociodemographic and clinical characteristics of patients. Results: The sample included 109 patients (age: 46.08 ± 10.49 years; 68.8% male). The pain experience was independent of HRQL and sleep. Relationships among HRQL, pain and sleep associated to sociodemographic and clinical factors were not detected (p > 0.05). Patients with CDC category A showed moderate to high correlations among HRQL, pain and sleep. In CDC B-type patients, a moderate correlation was observed between pain and mental health. In CDC C patients, moderate correlations were observed between HRQL and sleep and pain and sleep, with no correlations between HRQL and pain. Conclusions: HRQL, pain and sleep are differently correlated in HIV patients depending on their clinical stage. Neither the nadir of CD4-T cells nor the current count of CD4-T cells was found to be related with HRQL, pain or sleep.
Collapse
|
3
|
Ribeiro LCS, Freitas MIDF, Tupinambás U, Lana FCF. Late diagnosis of Human Immunodeficiency Virus infection and associated factors. Rev Lat Am Enfermagem 2020; 28:e3342. [PMID: 32876290 PMCID: PMC7458569 DOI: 10.1590/1518-8345.4072.3342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/26/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE to analyze the occurrence of late diagnosis of infection by the Human Immunodeficiency Virus and its associated factors. METHOD this is an epidemiological, cross-sectional and analytical study, carried out with 369 people followed-up by Specialized Assistance Services, undergoing anti-retroviral treatment, and interviewed by means of a questionnaire. Univariate analysis was performed using Pearson's chi-square test or Fisher's exact test and Kruskall-Wallis test, and multivariate analysis using the ordinal logistic regression model of proportional odds. RESULTS the occurrence of 59.1% for late diagnosis of the infection was observed; the probability of later diagnosis is greater among people who have a steady partnership, when compared to those who do not; with increasing age, particularly above 35 years old; among those with lower schooling; for those who seek the health services to have an HIV test when they feel sick; and for those who test HIV less often or never do it after sex without a condom with a steady partner. CONCLUSION the knowledge on the high proportion of late diagnosis and its associated factors verified in this study make the planning and implementation of new policies and strategies aimed at the timely diagnosis of the infection imperative.
Collapse
Affiliation(s)
| | | | - Unaí Tupinambás
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | |
Collapse
|
4
|
Karaosmanoğlu HK, Mete B, Gündüz A, Aydin ÖA, Sargin F, Sevgi DY, Durdu B, Dökmetaş İ, Tabak F. Late presentation among patients with human immunodeficiency virus infection in Turkey. Cent Eur J Public Health 2019; 27:229-234. [PMID: 31580559 DOI: 10.21101/cejph.a5416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/30/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Late presentation of the patients with human immunodeficiency virus (HIV) infection is associated with less favourable treatment responses, more accelerated clinical progression, and a higher mortality risk. Although HIV prevalence is low in Turkey, it is steadily increasing and the information about late presentation among HIV-positives is limited. We aimed to analyze the status of late presentation among HIV-positive patients in Turkey. METHODS All newly diagnosed HIV/AIDS patients from 2003 to 2016 were enrolled in this study by five dedicated centres in Istanbul, Turkey. Demographic data, CD4+ counts, and HIV RNA were collected from medical records and were transferred to a HIV database system. Late pre- sentation was defined as presentation for care with a CD4 count < 350 cells/mm3 or presentation with an AIDS-defining event, regardless of the CD4 cell count. A medical literature search was done for the analysis of late presentation in Turkey. RESULTS The cohort included 1,673 patients (1,440 males, median age 35 years). Among them, 847 (50.6%) had an early diagnosis, with a CD count of more than 350 cells/mm3. The remaining 826 were late presenters. Among late presenters, 427 (25.5% of all, 51.7% of late presenters) presented with advanced HIV disease. Late presenters were more elderly and less educated. The gender seemed comparable between groups. Late presentation was more likely among married patients. Early presenters were more likely among homosexuals, those diagnosed in screening studies, and in lower HIV-RNA viral load category. There has been a decreasing trend among late presenters in 2011-2016 when compared to 2003-2011 period. CONCLUSION Current data suggest that half of HIV-infected patients present late in Turkey. In our cohort, those presented late were more elderly, less educated, married and had heterosexual intercourse. On admission, late presenters had more HIV-related diseases and were more likely in higher HIV-RNA category. In the cohort, men having sex with men were less likely late presenters. Efforts to reduce the proportion of late presentation are essential for almost every country. The countries should identify the risk factors of late presentation and should improve early diagnosis and presentation for HIV care.
Collapse
Affiliation(s)
- Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bilgül Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Alper Gündüz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Altuntaş Aydin
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Dilek Yildiz Sevgi
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bülent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - İlyas Dökmetaş
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
5
|
Pallotta AM, Pirzada SA, Shrestha RK, Yen-Lieberman B, Calabrese LH, Taege AJ, Butler RS, Abbas UL. Presentation to HIV care and antiretroviral therapy initiation and response in clinical practice from 2003 through 2013. Int J STD AIDS 2019; 30:853-860. [PMID: 31280687 DOI: 10.1177/0956462419841219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Universal HIV screening and treatment initiation of HIV-positive persons are well-established standards. However, late presentation to care is a barrier to early antiretroviral therapy (ART) and prevention of HIV transmission. We sought to determine the immunodeficiency at presentation to care and characterize the initiation and response to ART among HIV-positive persons over 2003–2013 in our urban HIV clinical practice at the Cleveland Clinic. Using a retrospective cohort study design, we assessed the CD4 cell count of HIV-positive patients at entry into care for each year and evaluated the trend over time. For patients who initiated treatment, we assessed the pretreatment CD4 cell count, consistency of timing and regimen with US treatment guidelines, and HIV RNA level at one-year and last follow-up visits. Regression analyses were used to determine predictors of study outcomes. We found that the cohort (N = 452) median CD4 cell count at presentation to care was 297 cells/mm3 (inter-quartile range: 104–479 cells/mm3), without any significant change over time (P = 0.62), and with 37% and 21% of presentations being late and advanced, respectively. Guideline-consistency (85%–100%) and regimen-consistency (41%–100%) were moderate to high and improved over time. Virologic suppression (<400 copies/ml) at one year and last follow-up was high (79% and 92%) and associated with regimen selection and durability. We conclude that CD4 cell count at first presentation to HIV care remained less than 350 cells/mm3 for 11 years in our clinical practice, despite advances in HIV testing and treatment guidelines. Early diagnosis and linkage to care and treatment are critical for ending the HIV epidemic.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ume L Abbas
- 1 Cleveland Clinic, Cleveland, OH, USA.,2 Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
6
|
Cerini C, Casari S, Donato F, Porteri E, Rodella A, Terlenghi L, Compostella S, Apostoli A, Brianese N, Urbinati L, Salvi A, Rossini A, Agabiti Rosei E, Caruso A, Carosi G, Castelli F. Trigger-oriented HIV testing at Internal Medicine hospital Departments in Northern Italy: an observational study (Fo.C.S. Study). Infect Dis (Lond) 2016; 48:838-43. [PMID: 27622515 DOI: 10.3109/23744235.2016.1169551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). METHODS Patients admitted to IMD of a General University Hospital in Italy in March-June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient's characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. RESULTS HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. CONCLUSIONS Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages.
Collapse
Affiliation(s)
- Carlo Cerini
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Salvatore Casari
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Francesco Donato
- b Institute of Hygiene, Epidemiology and Public Health , University of Brescia , Italy
| | - Enzo Porteri
- c Internal Medicine Unit , University of Brescia , Italy
| | - Anna Rodella
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | - Luigina Terlenghi
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | | | | | - Lucia Urbinati
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Andrea Salvi
- e Internal Medicine Unit 3 , Spedali Civili General Hospital , Brescia , Italy
| | - Angelo Rossini
- f Hepatology Unit , Spedali Civili General Hospital , Brescia , Italy
| | | | - Arnaldo Caruso
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | - Francesco Castelli
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy ;,h Training and empowering human resources for health development in resource-limited countries , University of Brescia , Brescia , Italy
| |
Collapse
|
7
|
Hernández-Romieu AC, del Rio C, Hernández-Ávila JE, Lopez-Gatell H, Izazola-Licea JA, Uribe Zúñiga P, Hernández-Ávila M. CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014. PLoS One 2016; 11:e0152444. [PMID: 27027505 PMCID: PMC4814060 DOI: 10.1371/journal.pone.0152444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/14/2016] [Indexed: 01/24/2023] Open
Abstract
In Mexico, public health services have provided universal access to antiretroviral therapy (ART) since 2004. For individuals receiving HIV care in public healthcare facilities, the data are limited regarding CD4 T-lymphocyte counts (CD4e) at the time of entry into care. Relevant population-based estimates of CD4e are needed to inform strategies to maximize the impact of Mexico's national ART program, and may be applicable to other countries implementing universal HIV treatment programs. For this study, we retrospectively analyzed the CD4e of persons living with HIV and receiving care at state public health facilities from 2007 to 2014, comparing CD4e by demographic characteristics and the marginalization index of the state where treatment was provided, and assessing trends in CD4e over time. Our sample included 66,947 individuals who entered into HIV care between 2007 and 2014, of whom 79% were male. During the study period, the male-to-female ratio increased from 3.0 to 4.3, reflecting the country's HIV epidemic; the median age at entry decreased from 34 years to 32 years. Overall, 48.6% of individuals entered care with a CD4≤200 cells/μl, ranging from 42.2% in states with a very low marginalization index to 52.8% in states with a high marginalization index, and from 38.9% among individuals aged 18-29 to 56.5% among those older than 50. The adjusted geometric mean (95% confidence interval) CD4e increased among males from 135 (131,142) cells/μl in 2007 to 148 (143,155) cells/μl in 2014 (p-value<0.0001); no change was observed among women, with a geometric mean of 178 (171,186) and 171 (165,183) in 2007 and 2014, respectively. There have been important gains in access to HIV care and treatment; however, late entry into care remains an important barrier in achieving optimal outcomes of ART in Mexico. The geographic, socioeconomic, and demographic differences observed reflect important inequities in timely access to HIV prevention, care, and treatment services, and highlight the need to develop contextual and culturally appropriate prevention and HIV testing strategies and linkage programs.
Collapse
Affiliation(s)
- Alfonso C. Hernández-Romieu
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Carlos del Rio
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Center for AIDS Research, Emory University, Atlanta, GA, United States of America
| | | | | | - José Antonio Izazola-Licea
- National Center for Prevention and Control of HIV/AIDS (CENSIDA), Mexico City, Mexico
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland
| | - Patricia Uribe Zúñiga
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland
| | | |
Collapse
|
8
|
Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, Sönnerborg A. Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden. HIV Med 2015; 17:425-35. [PMID: 26559921 DOI: 10.1111/hiv.12321] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to identify factors in HIV-infected patients and the health care system which contribute to late diagnosis. METHODS All patients who were newly diagnosed with HIV infection at 12 clinics in Sweden over a period of 2.5 years (n = 575) were included in the study, corresponding to three-quarters of newly diagnosed HIV infections in the country. The patients were classified as non-late presenters or late presenters (LPs), defined as those with a CD4 count < 350 cells/μL or AIDS. LPs were subdivided into those without and those with advanced HIV disease, which was defined as a CD4 count < 200 cells/μL or AIDS. Demographics, missed AIDS and HIV-associated symptoms in the preceding 3 years, immigration date, and health examination at immigration were recorded. RESULTS Fifty-eight per cent of the patients were LPs, of whom 66% had advanced disease. Age > 30 years, origin in sub-Saharan Africa or Eastern Europe/Asia/the Pacific region, and country of transmission being in sub-Saharan Africa or unknown were associated with late presentation. Half of the patients of non-Swedish origin had lived for more than 1 year in Sweden at diagnosis and 66% had a missed HIV testing opportunity at immigration. Twenty-seven per cent of all patients had presented for health care with AIDS- and/or HIV-associated conditions without having an HIV test. Sixteen per cent had a history of symptoms without seeking care. CONCLUSIONS Deficiencies in the health care system with missed HIV testing opportunities contribute to the high proportion of late presenters in Sweden, especially among migrants. With increased testing at immigration and further incorporation of "indicator-guided" testing in general practice, most patients could be diagnosed earlier.
Collapse
Affiliation(s)
- J Brännström
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - V Svedhem Johansson
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - G Marrone
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Wendahl
- Department of Infectious Diseases, Sunderbyn Hospital, Luleå, Sweden
| | - A Yilmaz
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - A Blaxhult
- Department of Clinical Science and Education, Venhälsan, South General Hospital, Stockholm, Sweden
| | - A Sönnerborg
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
9
|
Valentini MB, Toledo MLGD, Fonseca MO, Thiersch LMS, Toledo ISBD, Machado FCJ, Tupinambás U. Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010. Braz J Infect Dis 2015; 19:253-62. [PMID: 25769736 PMCID: PMC9425387 DOI: 10.1016/j.bjid.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 11/05/2022] Open
Abstract
Introduction Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients’ survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. Methods A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm3 or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm3 or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm3 (IQR: 130–531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. Conclusion The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed.
Collapse
Affiliation(s)
- Melissa Bianchetti Valentini
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Voluntary Counseling and Testing Site/Specialized Center in HIV Outclinic Patients Care (CTA-SAE), Belo Horizonte, MG, Brazil.
| | - Maria Luíza Guerra de Toledo
- National School of Statistical Science-Instituto Brasileiro de Geografia e Estatística (IBGE), Rio de Janeiro, RJ, Brazil
| | - Marise Oliveira Fonseca
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | | | - Unaí Tupinambás
- Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
10
|
Dourado I, MacCarthy S, Lima C, Veras MA, Kerr L, de Brito AM, Gruskin S. What's pregnancy got to do with it? Late presentation to HIV/AIDS services in Northeastern Brazil. AIDS Care 2014; 26:1514-20. [PMID: 25033205 DOI: 10.1080/09540121.2014.938016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm(3). Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.
Collapse
Affiliation(s)
- Inês Dourado
- a Instituto de Saúde Coletiva/Universidade Federal da Bahia , Salvador , Brazil
| | | | | | | | | | | | | |
Collapse
|
11
|
Van Wagoner N, Mugavero M, Westfall A, Hollimon J, Slater LZ, Burkholder G, Raper JL, Hook EW. Church attendance in men who have sex with men diagnosed with HIV is associated with later presentation for HIV care. Clin Infect Dis 2013; 58:295-9. [PMID: 24198225 DOI: 10.1093/cid/cit689] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We demonstrate an interdependent relationship between sexual behavior and church attendance on timing of human immunodeficiency virus (HIV) diagnosis and presentation for care. Men who have sex with men (MSM) and who attend church are more likely to present with lower CD4(+) T-lymphocyte counts than MSM who do not attend church.
Collapse
Affiliation(s)
- Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Hall HI, Halverson J, Wilson DP, Suligoi B, Diez M, Le Vu S, Tang T, McDonald A, Camoni L, Semaille C, Archibald C. Late diagnosis and entry to care after diagnosis of human immunodeficiency virus infection: a country comparison. PLoS One 2013; 8:e77763. [PMID: 24223724 PMCID: PMC3818378 DOI: 10.1371/journal.pone.0077763] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 12/12/2022] Open
Abstract
Background Testing for HIV infection and entry to care are the first steps in the continuum of care that benefit individual health and may reduce onward transmission of HIV. We determined the percentage of people with HIV who were diagnosed late and the percentage linked into care overall and by demographic and risk characteristics by country. Methods Data were analyzed from national HIV surveillance systems. Six countries, where available, provided data on two late diagnosis indicators (AIDS diagnosis within 3 months of HIV diagnosis, and AIDS diagnosis within 12 months before HIV diagnosis) and linkage to care (≥1 CD4 or viral load test result within 3 months of HIV diagnosis) for people diagnosed with HIV in 2009 or 2010 (most recent year data were available). Principal Findings The percentage of people presenting with late stage disease at HIV diagnosis varied by country, overall with a range from 28.7% (United States) to 8.8% (Canada), and by transmission categories. The percentage of people diagnosed with AIDS who had their initial HIV diagnosis within 12 months before AIDS diagnosis varied little among countries, except the percentages were somewhat lower in Spain and the United States. Overall, the majority of people diagnosed with HIV were linked to HIV care within 3 months of diagnosis (more than 70%), but varied by age and transmission category. Conclusions Differences in patterns of late presentation at HIV diagnosis among countries may reflect differences in screening practices by providers, public health agencies, and people with HIV. The percentage of people who received assessments of immune status and viral load within 3 months of diagnosis was generally high.
Collapse
Affiliation(s)
- H. Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Jessica Halverson
- Public Health Agency of Canada/Agence de la santé publique du Canada, Ontario, Canada
| | - David P. Wilson
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mercedes Diez
- Secretaría del Plan Nacional sobre el Sida/Centro Nacional de Epidemiología, Madrid, Spain
| | | | - Tian Tang
- ICF Marcro International, Atlanta, Georgia, United States of America
| | - Ann McDonald
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Chris Archibald
- Public Health Agency of Canada/Agence de la santé publique du Canada, Ontario, Canada
| |
Collapse
|
13
|
Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward. AIDS Behav 2013; 17:5-30. [PMID: 22218723 DOI: 10.1007/s10461-011-0097-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Early commencement of antiretroviral treatment can be beneficial and economical in the long run. Despite global advances in access to care, a significant proportion of adults presenting at HIV/AIDS care facilities present with advanced HIV disease. Understanding factors associated with late presentation for HIV/AIDS services is critical to the development of effective programs and treatment strategies. Literature on factors associated with late presentation for an HIV diagnosis is reviewed. Highlighted is the current emphasis on socio-demographic factors, the limited exploration of psychosocial correlates, and inconsistencies in the definition of late presentation that make it difficult to compare findings across different studies. Perspectives based on experiences from resource limited settings are underreported. Greater exploration of psychosocial predictors of late HIV diagnosis is advocated for, to guide future intervention research and to inform public policy and practice targeted at 'difficult to reach' populations.
Collapse
|
14
|
Román-Montoya Y, Bueno-Cavanillas A, Lara-Porras AM. Evolution of HIV incubation times in AIDS patients. AIDS Care 2012; 25:1051-61. [PMID: 23244645 DOI: 10.1080/09540121.2012.748876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since introduction of highly active antiretroviral therapy (HAART), the incidence of AIDS has gradually declined, although the incidence of HIV infection is largely unknown. We have studied a sample with 10,571 patients whose data were recorded by Spain's public health system, in the Andalusian Register of Cases of AIDS. The diagnoses correspond to the period January 1981 to June 2008. For this period, AIDS incubation times were analyzed by means of the survival and risk functions, using R survival and DTDA libraries. We have studied the evolution of incubation mean times according to specific variables from database. The obtained results show that the mean times of viral incubation presented a growing trend that was greater among women when the study was limited to heterosexual transmission. Stratifying by category of transmission, the longest incubation period was seen for intravenous drug users (IDU). Both gender and IDU transmission were associated with significantly greater survival without AIDS. In contrast, heterosexual transmission or pneumonia diagnosis were associated with lower survival without AIDS.
Collapse
Affiliation(s)
- Y Román-Montoya
- Statistics and Operational Research, University of Granada, Campus de Fuentenueva, Spain.
| | | | | |
Collapse
|
15
|
Kall MM, Smith RD, Delpech VC. Late HIV diagnosis in Europe: A call for increased testing and awareness among general practitioners. Eur J Gen Pract 2012; 18:181-6. [DOI: 10.3109/13814788.2012.685069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
d'Arminio Monforte A, Cozzi-Lepri A, Girardi E, Castagna A, Mussini C, Di Giambenedetto S, Galli M, Cassola G, Vullo V, Quiros-Roldan E, Lo Caputo S, Antinori A. Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther 2012; 16:1103-12. [PMID: 22024526 DOI: 10.3851/imp1883] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND To study the prevalence, predictors and outcome of late HIV diagnosis in the Icona cohort, according to the new European consensus definition of late diagnosis. METHODS In this observational cohort study we investigated patients diagnosed with HIV over 3 months preceding enrolment who were defined as diagnosed late if they presented with AIDS or a CD4(+) T-cell count ≤ 350/mm³ (European consensus definition). We estimated the prevalence of late diagnosis, identified factors associated with being diagnosed late and looked at the prognostic value of the European consensus definition of late presentation to predict subsequent clinical progression (new AIDS events or death). RESULTS In total, 1,438/2,276 patients (63%) were defined as diagnosed late using the new European Consensus definition. Of these, 387 (16%) were AIDS-presenters. Predictors of being diagnosed late were older age, non-Italian origin, high HIV RNA and unemployment (versus retirement). A total of 293 patients showed clinical progression (3 events/100 person-years of follow-up, 95% CI: 2.7-3.4). Presenting late was strongly associated with a >5-fold increased risk of disease progression. CONCLUSIONS In our observational setting with free access to care, more than 60% of new HIV diagnoses occurred below the recommended threshold for initiating antiretroviral treatment. Presenting late for care was associated with a high risk of clinical progression.
Collapse
Affiliation(s)
- Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Medicine, Surgery and Dentistry, S Paolo Hospital, University of Milan, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Waters L, Sabin CA. Late HIV presentation: epidemiology, clinical implications and management. Expert Rev Anti Infect Ther 2012; 9:877-89. [PMID: 21973300 DOI: 10.1586/eri.11.106] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.
Collapse
Affiliation(s)
- Laura Waters
- St Stephens Research, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK
| | | |
Collapse
|
18
|
Imputation of the Date of HIV Seroconversion in a Cohort of Seroprevalent Subjects: Implications for Analysis of Late HIV Diagnosis. AIDS Res Treat 2011; 2012:725412. [PMID: 22013517 PMCID: PMC3195500 DOI: 10.1155/2012/725412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/27/2011] [Accepted: 08/04/2011] [Indexed: 12/02/2022] Open
Abstract
Objectives. Since subjects may have been diagnosed before cohort entry, analysis of late HIV diagnosis (LD) is usually restricted to the newly diagnosed. We estimate the magnitude and risk factors of LD in a cohort of seroprevalent individuals by imputing seroconversion dates. Methods. Multicenter cohort of HIV-positive subjects who were treatment naive at entry, in Spain, 2004–2008. Multiple-imputation techniques were used. Subjects with times to HIV diagnosis longer than 4.19 years were considered LD. Results. Median time to HIV diagnosis was 2.8 years in the whole cohort of 3,667 subjects. Factors significantly associated with LD were: male sex; Sub-Saharan African, Latin-American origin compared to Spaniards; and older age. In 2,928 newly diagnosed subjects, median time to diagnosis was 3.3 years, and LD was more common in injecting drug users. Conclusions. Estimates of the magnitude and risk factors of LD for the whole cohort differ from those obtained for new HIV diagnoses.
Collapse
|
19
|
López A, Palacios R, Merino D, Santos J. Retraso diagnóstico de la infección por el VIH en Andalucía. Enferm Infecc Microbiol Clin 2011; 29:639-40. [DOI: 10.1016/j.eimc.2011.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/11/2011] [Indexed: 11/25/2022]
|
20
|
HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV. AIDS 2011; 25:1017-23. [PMID: 21422986 DOI: 10.1097/qad.0b013e3283467087] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many people who are HIV positive are unaware of their infection status. Estimation of the number of people with undiagnosed HIV within a country or region is vital for understanding future need for treatment and for motivating testing programs. We review the available estimation approaches which are in current use. They can be broadly classified into those based on prevalence surveys and those based on reported HIV and AIDS cases. Estimation based on prevalence data requires data from regular prevalence surveys in different population groups together with estimates of the size of these groups. The recommended minimal case reporting data needed to estimate the number of patients with undiagnosed HIV are HIV diagnoses, including CD4 count at diagnosis and whether there has been an AIDS diagnosis in the 3 months before or after HIV diagnosis, and data on deaths in people with HIV. We would encourage all countries to implement several methods that will help develop our understanding of strengths and weaknesses of the various methods.
Collapse
|
21
|
Antinori A, Johnson M, Moreno S, Rockstroh JK, Yazdanpanah Y. Introduction to late presentation for HIV treatment in Europe. Antivir Ther 2010; 15 Suppl 1:1-2. [PMID: 20442454 DOI: 10.3851/imp1521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This publication is based on the proceedings of a meeting of European HIV experts convened in Windsor, UK, in March 2009. The meeting reviewed data in four key topics affecting the late presentation of HIV patients in Europe: the definition and epidemiology of late presentation, its medical and societal consequences, the need for earlier HIV testing and strategies for management of late-presenting patients. Each topic is discussed in detail here. A concluding article presents recommendations in each topic that were developed at the meeting to address the continuing challenge represented by late presentation for HIV treatment.
Collapse
|
22
|
Rockstroh JK, Gatell J, Landman R, Antinori A. Management of late-presenting patients with HIV infection. Antivir Ther 2010; 15 Suppl 1:25-30. [PMID: 20442458 DOI: 10.3851/imp1527] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Managing patients who present late with HIV infection is challenging. All late-presenting patients should have an individual treatment plan that encompasses both antiretroviral therapy and, where necessary, treatment for opportunistic diseases. Timely initiation of treatment in late presenters is crucial but the optimal time to start therapy depends on many individual factors, including the presence of opportunistic infection and potential drug-drug interactions. Primary drug resistance is an important contributor to poor clinical outcomes in HIV; resistance profiling before treatment initiation is therefore recommended. The choice of initial HIV treatment should reflect patient characteristics, the results of resistance testing and the complexity of concomitant disease.
Collapse
|
23
|
Yazdanpanah Y, Lange J, Gerstoft J, Cairns G. Earlier testing for HIV – how do we prevent late presentation? Antivir Ther 2010; 15 Suppl 1:17-24. [DOI: 10.3851/imp1526] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|