1
|
d'Arminio Monforte A, Tavelli A, Di Biagio A, Sarmati L, Marchetti GC, Bai F, Cingolani A, Quiros Roldan E, Mussini C, Lichtner M, Vergori A, Piconi S, Orofino G, Fusco FM, Bandera A, Nozza S, Castagna A, Antinori A. Long-term outcomes of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy and as switch strategy in virologically suppressed persons with HIV: data from the ICONA cohort. J Antimicrob Chemother 2024; 79:1279-1288. [PMID: 38581349 DOI: 10.1093/jac/dkae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/06/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVES To assess the effectiveness of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) among people poorly represented in clinical trials and potentially at higher risk of suboptimal response to ART. METHODS Observational cohort study on persons with HIV (PWH) enrolled in ICONA who started BIC/FTC/TAF as initial therapy or as switching regimen while virologically suppressed. Primary endpoint was time to treatment failure (TF): new AIDS/death or virological failure (VF) or discontinuation for toxicity/failure. Secondary endpoints were time to treatment discontinuation for toxicity (TDT) and to VF. Groups of interest were those aged >50 years, female sex, and advanced HIV disease at first ART start. Probability of the events overall and according to groups and adjusted HR for every endpoint were calculated by Kaplan-Meier curves and Cox regression models. RESULTS Nine hundred and thirty-three ART-naive and 1655 ART-experienced PWH initiated BIC/FTC/TAF. Over a median follow-up of 69.8 weeks, 89 (9.6%) PWH at their first regimen experienced TF. PWH aged >50 years had 1.83-fold (95% CI: 1.19-2.83) higher risk of TF; PWH with advanced HIV disease had 2.21-fold (95% CI: 1.53-3.82) higher risk; there were no differences in TF according to sex.Over a median follow-up of 146.3 weeks, 109 (6.6%) out of 1655 switching PWH experienced TF; no differences were found in the risk of TF, TDT and VF according to groups of interest. CONCLUSIONS Overall, BIC/FTC/TAF is well tolerated and virologically effective in the real-world scenario for ART-naive and -experienced PWH. Older ART-naive PWH and those with advanced HIV disease may respond less well as the burden of diseases might compromise treatment efficacy.
Collapse
Affiliation(s)
| | | | - Antonio Di Biagio
- Department of Health Sciences IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Loredana Sarmati
- Department of Medicine of Systems, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Giulia C Marchetti
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Quiros Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, Infectious Diseases Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Piconi
- Infectious Diseases Unit, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonella Castagna
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| |
Collapse
|
2
|
Mondi A, Cozzi-Lepri A, Tavelli A, Cingolani A, Giacomelli A, Orofino G, De Girolamo G, Pinnetti C, Gori A, Saracino A, Bandera A, Marchetti G, Girardi E, Mussini C, d'Arminio Monforte A, Antinori A. Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis - results from the ICONA cohort in Italy, 2009-2022. Int J Infect Dis 2024; 142:106995. [PMID: 38458423 DOI: 10.1016/j.ijid.2024.106995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD). METHODS All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated. RESULTS Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS-related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure. CONCLUSIONS In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.
Collapse
Affiliation(s)
- Annalisa Mondi
- Clinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | | | - Antonella Cingolani
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Giacomelli
- Division 3 of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Gabriella De Girolamo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Carmela Pinnetti
- Clinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Gori
- Division 2 of Infectious Diseases, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Bari, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero Universitaria Policlinico of Modena, Modena, Italy
| | | | - Andrea Antinori
- Clinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| |
Collapse
|
3
|
Gagliardini R, Tavelli A, Rusconi S, Lo Caputo S, Spagnuolo V, Santoro MM, Costantini A, Vergori A, Maggiolo F, Giacomelli A, Burastero G, Madeddu G, Quiros Roldan E, d'Arminio Monforte A, Antinori A, Cozzi-Lepri A. Characterization and outcomes of difficult-to-treat patients starting modern first-line ART regimens: Data from the ICONA cohort. Int J Antimicrob Agents 2024; 63:107018. [PMID: 38214244 DOI: 10.1016/j.ijantimicag.2023.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Treatment failures to modern antiretroviral therapy (ART) raise concerns, as they could reduce future options. Evaluations of occurrence of multiple failures to modern ART are missing and their significance in the long run is unclear. METHODS People with HIV (PWH) in the ICONA cohort who started a modern first-line ART were defined as 'difficult to treat' (DTT) if they experienced ≥1 among: i) ≥2 VF (2 viral loads, VL>200 copies/mL or 1 VL>1000 copies/mL) with or without ART change; ii) ≥2 treatment discontinuations (TD) due to toxicity/intolerance/failure; iii) ≥1 VF followed by ART change plus ≥1 TD due to toxicity/intolerance/failure. A subgroup of the DTT participants were matched to PWH that, after the same time, were non-DTT. Treatment response, analysing VF, TD, treatment failure, AIDS/death, and SNAE (Serious non-AIDS event)/death, were compared. Survival analysis by KM curves and Cox regression models were employed. RESULTS Among 8061 PWH, 320 (4%) became DTT. Estimates of becoming DTT was 6.5% (95% CI: 5.8-7.4%) by 6 years. DTT PWH were significantly older, with a higher prevalence of AIDS and lower CD4+ at nadir than the non-DTT. In the prospective analysis, DTT demonstrated a higher unadjusted risk for all the outcomes. Once controlled for confounders, significant associations were confirmed for VF (aHR 2.23, 1.33-3.73), treatment failure (aHR 1.70, 1.03-2.78), and SNAE/death (aHR 2.79, 1.18-6.61). CONCLUSION A total of 6.5% of PWH satisfied our definition of DTT by 6 years from ART starting. This appears to be a more fragile group who may have higher risk of failure.
Collapse
Affiliation(s)
- Roberta Gagliardini
- INMI L Spallanzani IRCCS, Clinical Department of Infectious Diseases and Research, Roma, Italy.
| | | | - Stefano Rusconi
- Ospedale di Legnano, Struttura Complessa Malattie Infettive, Legnano, Italy and DIBIC, University of Milan, Italy
| | | | - Vincenzo Spagnuolo
- IRCCS San Raffaele Scientific Institute, Infectious Diseases Unit, Milan, Italy
| | | | - Andrea Costantini
- Clinical Immunology Unit, Azienda Ospedaliero Universitaria delle Marche and Marche Polytechnic University, Ancona, Italy
| | - Alessandra Vergori
- INMI L Spallanzani IRCCS, Clinical Department of Infectious Diseases and Research, Roma, Italy
| | - Franco Maggiolo
- ASST Papa Giovanni XXIII, Infectious Diseases Unit, Bergamo, Italy
| | - Andrea Giacomelli
- ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, III Infectious Diseases Unit, Milano, Italy
| | - Giulia Burastero
- Azienda Ospedaliero-Universitaria di Modena, Infectious Disease Clinic, Modena, Italy
| | - Giordano Madeddu
- University of Sassari, Department of Medical, Surgical, and Experimental Sciences, Sassari, Italy
| | - Eugenia Quiros Roldan
- University of Brescia and ASST Spedali Civili of Brescia, Department of Infectious and Tropical Diseases, Brescia, Italy
| | | | - Andrea Antinori
- INMI L Spallanzani IRCCS, Clinical Department of Infectious Diseases and Research, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Institute for Global Health, UCL, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), London, United Kingdom
| |
Collapse
|
4
|
Kostaki EG, Limnaios S, Adamis G, Xylomenos G, Chini M, Mangafas N, Lazanas M, Patrinos S, Metallidis S, Tsachouridou O, Papastamopoulos V, Chatzidimitriou D, Antoniadou A, Papadopoulos A, Protopapas K, Tsiara C, Psichogiou M, Basoulis D, Pilalas D, Paraskeva D, Chrysos G, Paparizos V, Kourkounti S, Sambatakou H, Bolanos V, Sipsas NV, Lada M, Barbounakis E, Kantzilaki E, Panagopoulos P, Petrakis V, Drimis S, Katsarolis I, Lagiou P, Hatzakis A, Magiorkinis G, Skoura L, Paraskevis D. Estimation of the determinants for HIV late presentation using the traditional definition and molecular clock-inferred dates: Evidence that older age, heterosexual risk group and more recent diagnosis are prognostic factors. HIV Med 2022; 23:1143-1152. [PMID: 36258653 PMCID: PMC10092532 DOI: 10.1111/hiv.13415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES HIV late presentation (LP) has been increasing in recent years in Europe. Our aim was to investigate the characteristics of LP in Greece using in addition to the traditional definition for LP, the time interval between HIV infection and diagnosis. METHODS Our nationwide sample included HIV-1 sequences generated from 6166 people living with HIV (PLWH) in Greece during the period 1999-2015. Our analysis was based on the molecularly inferred HIV-1 infection dates for PLWH infected within local molecular transmission clusters of subtypes A1 and B. RESULTS Analysis of the determinants of LP was conducted using either CD4 counts or AIDS-defining condition at diagnosis or the time from infection to diagnosis. Older age, heterosexual transmission risk group and more recent diagnosis were associated with increased risk for LP. In contrast to previous studies, people who inject drugs (PWID) had a shorter median time to diagnosis (0.63 years) compared to men who have sex with men (MSM) (1.72 years) and heterosexuals (2.43 years). Using HIV infection dates that provide an unbiased marker for LP compared to CD4 counts at diagnosis, which are age-dependent, we estimated that the time to diagnosis increased gradually with age. Migrants infected regionally do not differ with respect to LP status compared to native Greeks. CONCLUSIONS We demonstrate that older people and heterosexuals are among those at higher risk for LP; and given the growing number of older people among newly diagnosed cases, tailored interventions are needed in these populations.
Collapse
Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Georgios Xylomenos
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | | | - Simeon Metallidis
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Tsachouridou
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Pilalas
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Paraskeva
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | - Georgios Chrysos
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | - Vasileios Paparizos
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Sofia Kourkounti
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Bolanos
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - Emmanouil Barbounakis
- Department of Internal Medicine, University Hospital of Heraklion "PAGNI", Medical School, University of Crete, Heraklion, Greece
| | - Evrikleia Kantzilaki
- Department of Internal Medicine, University Hospital of Heraklion "PAGNI", Medical School, University of Crete, Heraklion, Greece
| | - Periklis Panagopoulos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasilis Petrakis
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stelios Drimis
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | | | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lemonia Skoura
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Sharafi M, Mirahmadizadeh A, Hassanzadeh J, Seif M. Prevalence of Late Presenters and Advanced HIV Disease in HIV Patients and Their Related Factors in Iran: Results from 19 Years of National Surveillance HIV Data. AIDS Res Hum Retroviruses 2022; 38:890-897. [PMID: 36166224 DOI: 10.1089/aid.2022.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Late presenters (LP) and Advanced HIV Disease (AHD) represent important missed opportunities to reduce secondary transmission and undesirable HIV outcomes. Despite efforts, the diagnoses are still delayed for the majority of patients. This cross-sectional study was conducted using the Iranian national HIV surveillance database from 2001 to 2019, to determine the factors affecting AHD and LP in Iran. To determine LP (CD4 ≤ 350 cells/μL) and AHD (CD4 ≤ 200 cells/μL), the first patients' CD4 at baseline were used. To examine the relationship between the covariates and LP or AHD, a Logistic Regression was applied. The adjusted odds ratio (AOR) stated to report the relationship. Totally, 13,571 patients were included in the study. Of these, 4,060 (29.92%) were AHD and 7,161 (52.77%) LP. Female gender [AOR = 0.88, 95% confidence interval (CI): 0.80-0.97], higher education (AOR = 0.80, 95% CI: 0.69-0.93), and having a positive HIV spouse (AOR = 0.75, 95% CI = 0.66-0.85) significantly decreased odds of LP (p < .05). However, older age (AOR = 2.53, 95% CI: 2.20-2.91) was a risk factor for LP. For AHD, years of detection (AOR = 1.16, 95% CI: 1.06-1.27), older age (AOR = 2.49, 95% CI: 2.12-2.92), and having a spouse with high-risk behavior (AOR = 1.23, 95% CI: 1.02-1.49) led to higher odds. (p < .05). Also, female (AOR = 0.82, 95% CI: 0.73-0.92) and having a positive HIV spouse (AOR = 0.67, 95% CI: 0.58-0.78) were protective factors for ADH. The present study estimated that approximately two-thirds of HIV patients are LP and one-third are AHD in Iran. Older age, male gender, lower education, and having a spouse with high-risk behavior were the factors affecting LP and AHD. Thus, to reduce the percentage of patients with LP and AHD in Iran, improvements in knowledge and periodic screening programs are necessary for these groups.
Collapse
Affiliation(s)
- Mehdi Sharafi
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hassanzadeh
- Research Centre for Health Sciences, Institute of Health, School of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
6
|
Determinants of Late HIV Presentation at Ndlavela Health Center in Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084568. [PMID: 35457436 PMCID: PMC9031287 DOI: 10.3390/ijerph19084568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
Background: There has been tremendous progress in the fight against HIV worldwide; however, challenges persist in the control of HIV infection. These challenges include the high prevalence of late presenters. There are many disadvantages of late presentation—from reduced survival of the infected person to the risk of transmitting the infection. This research aims to analyze the factors that influence the late presentation in patients attending Ndlavela Health Center in Mozambique. Methodology: A retrospective cross-sectional study was carried out at Ndlavela Health Center including patients diagnosed with HIV between 2015 and 2020. The European Late Presenter Consensus working group definitions were used, and univariate and multivariate logistic regression were used to identify factors associated with late presentation. Results: In total, 519 participants were included in the study, of which nearly 47% were classified as late presenters. The male gender (AOR = 2.41), clinical suspicious test (AOR = 4.03), initiated by the health professional (AOR = 2.1,9), and fear of stigma (AOR = 2.80) were the main risk factors for late HIV presentation. Conclusion: Factors that are potentially determinant for late HIV presentation were identified. Actions are needed to focus on risk factors that are most likely to delay presentation.
Collapse
|
7
|
Nduaguba SO, Ford KH, Wilson JP, Lawson KA, Cook RL. Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state. Int J STD AIDS 2020; 32:162-169. [PMID: 33327899 PMCID: PMC7879228 DOI: 10.1177/0956462420947567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.
Collapse
Affiliation(s)
- Sabina O Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Kentya H Ford
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - James P Wilson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
8
|
Lagi F, Kiros ST, Di Giambenedetto S, Lombardi F, Pecorari M, Borghi V, Lepore L, Monno L, Setti M, Micheli V, Bagnarelli P, Paolini E, Bai F, Bartoloni A, Sterrantino G. Long-term maintenance of virologic suppression in native and migrant HIV-1 naïve patients: an Italian cohort study. AIDS Care 2020; 33:1159-1166. [PMID: 33172289 DOI: 10.1080/09540121.2020.1839011] [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: 10/23/2022]
Abstract
Little is known about long-term maintenance of virologic suppression in HIV migrants in Italy. The study aims to compare virologic failure rates and associated factors among antiretroviral therapy (ART)-naïve migrants and natives enrolled in the ARCA database since 2007 who achieved virologic suppression within 18 months from the beginning of the ART. Kaplan-Meier method assessed the probability of virologic suppression and failure. Cox regression model was used for multivariate analysis. Of 2515 patients, 2020 (80.3%) were Italian, 286 (10.6%) migrants from low-income countries, of whom 201 (75.0%) from Africa, and 227 (9.0%) from high-income-countries. The median follow-up was 4.5 years (IQR 2.5-7). No difference was observed in the time of achievement of virological suppression in the three groups (log-rank: p = 0.5687). Higher probability of virologic failure was observed in Africans compared to Italians, to patients from high-income-countries and from low-income-countries other than Africans (Log-rank = p < 0.001). In the adjusted analysis, a higher virologic failure risk was found in Africans only compared to Italians. [HR 4.01; 95% CI 2.44-6.56, p < 0.001]. In Italy, African migrants are less likely to maintain virologic suppression compared to natives and other migrants. Targeted interventions could be needed for foreigners, especially for Africans.
Collapse
Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Francesca Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Monica Pecorari
- Unit of Virology and Molecular Microbiology, University Hospital, Modena, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, University of Modena, Modena, Italy
| | - Luciana Lepore
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy
| | - Laura Monno
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy
| | - Maurizio Setti
- Clinic of Immunology and Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Micheli
- Microbiology and Virology Laboratory, L. Sacco Hospital, Milano, Italy
| | - Patrizia Bagnarelli
- Virology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elisabetta Paolini
- Immuno-Ematology and Transfusion Medicine Service, Cremona Hospital, Cremona, Italy
| | - Francesca Bai
- Infectious Diseases, San Paolo Hospital, Milan, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
9
|
Abstract
Employment is a social determinant of health that is important for understanding health behaviors, health outcomes and HIV transmission among people living with HIV. This study is a scoping review of the literature that addresses (a) the relationship between employment and the HIV continuum of care, (b) determinants of employment among PLWH and (c) experiences with employment. We searched two databases, PubMed and Embase, and identified a total of 5622 articles that were subjected to title and abstract review. Of these, 5387 were excluded, leaving 235 articles for full-text review. A total of 66 articles met inclusion criteria and were included in the study. The literature suggests that employment status is positively associated with HIV testing, linkage to HIV care, retention in HIV care, and HIV medication adherence. Guided by a social-ecological framework, we identified determinants of employment at the individual, interpersonal, organizational, community, and policy levels that are amenable to public health intervention. Experiences with employment, including barriers, facilitators, advantages, disadvantages, and needs, provide additional insight for future research and programs.
Collapse
Affiliation(s)
- Catherine H Maulsby
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Rm. 904C, Baltimore, MD, 21205, USA.
| | - Aneeka Ratnayake
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donna Hesson
- Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
10
|
Garagiola E, Foglia E, Ferrario L, Meraviglia P, Tebini A, Menzaghi B, Atzori C, Rizzardini G, Bini T, D'Arminio Monforte A, Croce D. Comorbidities and HCV coinfection in the management of HIV+ patients: evidence from the Italian clinical practice. HEALTH ECONOMICS REVIEW 2020; 10:27. [PMID: 32860539 PMCID: PMC7456501 DOI: 10.1186/s13561-020-00284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/05/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Since HIV+ treatment has become more effective, the average age of people living with HIV (PLWHIV) has increased, and consequently the incidence of developing comorbidities, making the clinical and economic management of HIV+ patients more complex. Limited literature exists regarding the management of comorbidities costs. This study is aimed at defining and comparing the total annual costs of comorbidities, in an Italian cohort of HIV and HIV/HCV patients, from the National Healthcare Service perspective. The authors hypothesised that there are higher costs, for patients with multiple comorbidities, and a greater consumption of resources for HIV/HCV co-infected patients versus HIV mono-infected patients. METHODS An observational retrospective multi-centre health-economics study, enrolling HIV+ and HIV/HCV consecutive patients with at least one comorbidity, was conducted. The consecutive cases, provided by three Italian infectious diseases centres, were related to the year 2016. The enrolled patients were on a stable antiviral therapy for at least six months. Demographic and clinical information was recorded. Costs related to HIV and HCV therapies, other treatments, medical examinations, hospitalizations and outpatient visits were evaluated. Data from mono-infected and co-infected groups of patients were compared, and the statistical analysis was performed by t-tests, chi-square and ANOVA. A sub-analysis excluding HCV therapy costs, was also conducted. The hierarchical sequential linear regression model was used to explore the determinants of costs, considering the investigated comorbidities. All analyses were conducted with a significant level of 0.05. RESULTS A total of 676 patients, 82% male, mean age 52, were identified and divided into groups (338 mono-infected HIV+ and 338 co-infected HIV/HCV patients), comparable in terms of age, gender, and demographic characteristics. A trend towards higher annual costs, for patients with multiple comorbidities was observed in HIV mono-infected patients (respectively € 8272.18 for patients without comorbidities and € 12,532.49 for patients with three or more comorbidities, p-value: 0.001). Excluding anti-HCV therapies costs, HIV/HCV co-infected patients generally required more resources, with statistically significant differences related to cardiovascular events (€10,116.58 vs €11,004.28, p-value: 0.001), and neurocognitive impairments events (€7706.43 vs €11,641.29 p- value: < 0.001). CONCLUSIONS This study provides a differentiated and comprehensive analysis of the healthcare resources needed by HIV and HIV/HCV patients with comorbidities and may contribute to the decision process of resources allocation, in the clinical management of different HIV+ patient populations.
Collapse
Affiliation(s)
- Elisabetta Garagiola
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy.
| | - Emanuela Foglia
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | | | | | | | | | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
11
|
Association between quality-of-care indicators for HIV infection and healthcare resource utilization and costs. AIDS 2020; 34:291-300. [PMID: 31714351 DOI: 10.1097/qad.0000000000002418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Multiple care quality indicators for HIV infection exist but few studies examine their impact on health outcomes. This study assessed which HIV care quality indicators were associated with healthcare resource utilization and costs. DESIGN Retrospective analysis of Texas Medicaid claims data (01 January 2012 to 31 September 2016). METHODS Included patients had at least two HIV-related medical claims during the identification period (01 July 2012 to 31 August 2014) (index = date of first HIV claim), were 18-62 years at index, and were continuously enrolled in the 6-month pre-index and 1-year post-index periods. Dependent variables included emergency department (ED) visits, inpatient hospitalizations, prescription count, and all-cause healthcare costs. Independent variables included CD4 cell count monitoring, syphilis, chlamydia, gonorrhea, hepatitis B, hepatitis C, and tuberculosis screenings, influenza and pneumococcal vaccinations, retention in care, and HAART initiation. Covariates included age, chronic hepatitis C virus infection, AIDS diagnosis, sex, and baseline healthcare cost. The study objective was addressed using generalized linear modeling. RESULTS CD4 cell count monitoring and HAART initiation were significantly associated with reduced emergency department visits (P < 0.0001 for each). Influenza vaccination was significantly associated with reduced inpatient hospitalization (P < 0.0001). CD4 cell count monitoring (P < 0.0001), TB screening (P = 0.0006), influenza vaccination (P < 0.0001), and HAART initiation (P < 0.0001) were significantly associated with increase prescription claims. CD4 cell count monitoring, TB screening, and HAART initiation (P < 0.0001 for each) were significantly associated with all-cause healthcare costs. CONCLUSION HAART may reduce use of emergency care services as early as 1 year following initiation.
Collapse
|
12
|
Pereira MF, Luz E, Netto EM, Barbosa MHF, Brites C. Low variation in initial CD4 cell count in a HIV referral center, in Salvador, Brazil, from 2002 to 2015. Braz J Infect Dis 2018; 22:245-247. [PMID: 29883585 PMCID: PMC9425651 DOI: 10.1016/j.bjid.2018.05.005] [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: 02/02/2018] [Revised: 04/21/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Abstract
Early initiation of antiretroviral therapy increases the likelihood of effective immune restoration, quality of life, and greater life expectancy for HIV-infected individuals. We evaluated the evolution of mean CD4+ cells count at diagnosis of HIV/AIDS in Salvador, Brazil from 2002 to 2015. We identified HIV/AIDS patients older than 18 years with diagnosis of HIV infection from 2002 to 2015, who had their first laboratory evaluation at Complexo Hospitalar Prof. Edgard Santos, Federal University of Bahia. Initial mean CD4+ cells count and age, over time were evaluated. A total of 1801 patients randomly selected individuals were included in the analysis. Overall mean CD4+ count at diagnosis in the whole period was 279 ± 265, varying from 191 in 2015 to 334 in 2011. There was no improvement in the immunological status at diagnosis from 2002 to 2015. In addition, a higher frequency of CD4+ cells count < 200 cells/mL in the last two years was observed. This suggests that the adopted strategies for early diagnosis of HIV/AIDS in Salvador, Brazil, are still ineffective.
Collapse
Affiliation(s)
- Marcela Fonseca Pereira
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Estela Luz
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Eduardo Martins Netto
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Manoel Henrique Fonseca Barbosa
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Carlos Brites
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil.
| |
Collapse
|
13
|
d'Arminio Monforte A, Lorenzini P, Cozzi-Lepri A, Mussini C, Castagna A, Baldelli F, Puoti M, Vichi F, Maddaloni A, Lo Caputo S, Gianotti N, Antinori A. Durability and tolerability of first-line regimens including two nucleoside reverse transcriptase inhibitors and raltegravir or ritonavir boosted-atazanavir or -darunavir: data from the ICONA Cohort<sup/>. HIV CLINICAL TRIALS 2018; 19:52-60. [PMID: 29493419 DOI: 10.1080/15284336.2018.1440691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background We aimed to mimic the ACTG 5257 trial, comparing raltegravir (RAL), ritonavir-boosted atazavavir (ATV/r) and ritonavir-boosted darunavir (DRV/r) in the observational setting. Methods All the ICONA patients starting a first cART with 2NRTI + ATV/r, DRV/r or RAL were included. Primary end-point was treatment failure, i.e. virological failure (confirmed HIV-RNA > 200copies/mL > 6 months therapy) or discontinuation for any reason of the third drug. Secondary end-points: virological failure50 (50 copies/mL threshold), and discontinuation of the third drug due to intolerance/toxicity. Cox regression analyses were run to compare the risk of outcomes between the three regimens. Results 2249 patients were included, 985 (44%) initiated ATV/r, 1023 (45%) DRV/r and 241 (11%) RAL; median follow-up of 3.6 years (IQR: 2.3-5.2). After controlling for baseline confounding factors, patients given ATV/r showed a 26% higher risk of treatment failure (TF) vs. DRV/r (AHR 1.26, 95%CI 1.11-1.43); patients on RAL had a lower risk of TF vs. ATV/r (AHR 0.81, 95%CI 0.66-0.99). The probability of virological failure50 was significantly lower for people initiating RAL vs. DRV/r (AHR 0.46, 95%CI 0.24-0.87) or ATV/r (AHR 0.52, 95%CI 0.27-0.99). In addition, RAL was associated to a lower risk of discontinuation for toxicity vs. both DRV/r (AHR: 0.37, 95%CI: 0.19-0.72) and ATV/r (AHR: 0.18, 95%CI: 0.09-0.34). ATV/r was associated with a higher risk of discontinuing due to toxicity (AHR 2.09, 95%CI 1.63-2.67) vs. DRV/r. Conclusions In our observational study, we confirmed higher risk of treatment failure and lower tolerability of ATV/r-based regimens as compared to those including DRV/r or RAL.
Collapse
Affiliation(s)
- Antonella d'Arminio Monforte
- a Department of Health Sciences, Clinic of Infectious and Tropical Diseases , University of Milan , Milan , Italy
| | - Patrizia Lorenzini
- b HIV/AIDS Clinical Department , National Institute for Infectious Diseases "Lazzaro Spallanzani" , Rome , Italy
| | - Alessandro Cozzi-Lepri
- c Department of Infection and Population Health, Division of Population Health , UCL Medical School, Royal Free Campus , London , UK
| | - Cristina Mussini
- d Infectious Disease Clinic , University of Modena and Reggio Emilia , Modena , Italy
| | - Antonella Castagna
- e Department of Infectious Diseases , San Raffaele Scientific Institute, University Vita-Salute San Raffaele , Milan , Italy
| | - Franco Baldelli
- f Unit of Infectious Diseases , University of Perugia , Perugia , Italy
| | - Massimo Puoti
- g Department of Infectious Diseases , Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Francesca Vichi
- h Unit of Infectious Diseases , Santa Maria Annunziata Hospital , Florence , Italy
| | - Adelaide Maddaloni
- i Unit for Immunodeficiencies and Gender Infectious Diseases , A.O. Dei Colli Cotugno Hospital , Naples , Italy
| | - Sergio Lo Caputo
- j UOC of Infectious Diseases , Policlinico di Bari , Bari , Italy
| | - Nicola Gianotti
- e Department of Infectious Diseases , San Raffaele Scientific Institute, University Vita-Salute San Raffaele , Milan , Italy
| | - Andrea Antinori
- b HIV/AIDS Clinical Department , National Institute for Infectious Diseases "Lazzaro Spallanzani" , Rome , Italy
| | | |
Collapse
|
14
|
Guaraldi G, Zona S, Menozzi M, Brothers TD, Carli F, Stentarelli C, Dolci G, Santoro A, Da Silva ARD, Rossi E, Falutz J, Mussini C. Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study. AIDS Res Ther 2017; 14:8. [PMID: 28209189 PMCID: PMC5311843 DOI: 10.1186/s12981-016-0129-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious comorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP and HIV + EP, respectively), and compare them to matched HIV-negative control participants from a community-based cohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in HIV patients. METHODS We performed a matched cohort study including HIV + LP and HIV + EP among people attending the Modena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative participants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of ≥2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity. RESULTS We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The mean age was 46 ± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the HIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated with increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after adjusting for age, multimorbidity, and antiretroviral costs. CONCLUSIONS LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and multimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently needed.
Collapse
|
15
|
Croce D, Lazzarin A, Rizzardini G, Gianotti N, Scolari F, Foglia E, Garagiola E, Ricci E, Bini T, Quirino T, Viganò P, Re T, D’Arminio Monforte A, Bonfanti P. HIV Clinical Pathway: A New Approach to Combine Guidelines and Sustainability of Anti-Retroviral Treatment in Italy. PLoS One 2016; 11:e0168399. [PMID: 28030621 PMCID: PMC5193418 DOI: 10.1371/journal.pone.0168399] [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: 06/10/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
The present article describes the case study of a “real world” HIV practice within the debate concerning the strategic role of Clinical Governance (CG) tools in the management of a National Healthcare System’s sustainability. The study aimed at assessing the impact of a Clinical Pathway (CP) implementation, required by the Regional Healthcare Service, in terms of effectiveness (virological and immunological conditions) and efficiency (economic resources absorption), from the budget holder perspective. Data derived from a multi-centre cohort of patients treated in 6 Hospitals that provided care to approximately 42% of the total HIV+ patients, in Lombardy Region, Italy. Two phases were compared: Pre-CP (2009–2010) vs. Post-CP implementation (2011–2012). All HIV infected adults, observed in the participating hospitals during the study periods, were enrolled and stratified into the 3 categories defined by the Regional CP: first-line, switch for toxicity/other, and switch for failure. The study population was composed of 1,284 patients (Pre-CP phase) and 1,135 patients (Post-CP phase). The results showed that the same level of virological and immunological effectiveness was guaranteed to HIV+ patients: 81.2% of Pre-CP phase population and 83.2% of Post-CP phase population had undetectable HIV-RNA (defined as <50 copies/mL) at 12-month follow up. CD4+ cell counts increased by 28 ± 4 cells/mm3 in Pre-CP Phase and 39 ± 5 cells/mm3 in Post-CP Phase. From an economic point of view, the CP implementation led to a substantial advantage: the mean total costs related to the management of the HIV disease (ART, hospital admission and laboratory tests) decreased (-8.60%) in the Post-CP phase (p-value < 0.0001). Results confirmed that the CP provided appropriateness and quality of care, with a cost reduction for the budget holder.
Collapse
Affiliation(s)
- Davide Croce
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adriano Lazzarin
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Fatebebefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Gianotti
- Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Scolari
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
| | - Emanuela Foglia
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
| | - Elisabetta Garagiola
- Centre for Research in Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Varese, Italy
- * E-mail:
| | - Elena Ricci
- Department of Infectious Diseases, Fatebebefratelli Sacco Hospital, Milan, Italy
| | - Teresa Bini
- Unit of Infectious Diseases, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Tiziana Quirino
- Department of Infectious Diseases, Valle Olona Hospital, Busto Arsizio, Italy
| | - Paolo Viganò
- Department of Infectious Diseases, Ovest Milanese Hospital, Legnano, Italy
| | - Tiziana Re
- Department of Infectious Diseases, Ovest Milanese Hospital, Legnano, Italy
| | | | - Paolo Bonfanti
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| |
Collapse
|
16
|
Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study. PLoS One 2016; 11:e0162503. [PMID: 27603207 PMCID: PMC5014346 DOI: 10.1371/journal.pone.0162503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. Methods A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. Results The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Conclusions Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.
Collapse
|
17
|
Raffetti E, Postorino MC, Castelli F, Casari S, Castelnuovo F, Maggiolo F, Di Filippo E, D'Avino A, Gori A, Ladisa N, Di Pietro M, Sighinolfi L, Zacchi F, Torti C. The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort. BMC Public Health 2016; 16:878. [PMID: 27557878 PMCID: PMC4997689 DOI: 10.1186/s12889-016-3477-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. METHODS All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. RESULTS 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. CONCLUSION Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.
Collapse
Affiliation(s)
- Elena Raffetti
- Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Maria Concetta Postorino
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy
| | - Francesco Castelli
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Salvatore Casari
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | - Franco Maggiolo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Elisa Di Filippo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Alessandro D'Avino
- Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, Ospedale "S. Gerardo", Monza, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Diseases, University of Bari, Bari, Italy
| | - Massimo Di Pietro
- Clinic of Infectious Diseases, "S. M. Annunziata" Hospital, Florence, Italy
| | - Laura Sighinolfi
- Clinic of Infectious Diseases, "S. Anna" Hospital, Ferrara, Italy
| | - Fabio Zacchi
- Clinic of Infectious Diseases, Istituti Ospitalieri Cremona, Cremona, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy.
| |
Collapse
|
18
|
MacCarthy S, Brignol S, Reddy M, Nunn A, Dourado I. Late presentation to HIV/AIDS care in Brazil among men who self-identify as heterosexual. Rev Saude Publica 2016; 50:54. [PMID: 27556968 PMCID: PMC4988802 DOI: 10.1590/s1518-8787.2016050006352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/06/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the factors associated with late presentation to HIV/AIDS services among heterosexual men. METHODS Men infected by HIV who self-identified as heterosexual (n = 543) were included in the study. Descriptive, biivariate and logistic regression analyses were performed to evaluate the factors associated with late presentation (defined as individuals whose first CD4 count was <350 cells/mm3) in the study population. RESULTS The prevalence of late presentation was 69.8%. The multivariate logistic analysis showed testing initiated by the provider (ORadjusted 3.75; 95%CI 2.45–5.63) increased the odds of late presentation. History of drug use (ORadjusted 0.59; 95%CI 0.38–0.91), history of having sexually transmitted infections (ORadjusted 0.64; 95%CI 0.42–0.97), and having less education (ORadjusted 0.63; 95%CI 0.41–0.97) were associated with a decreased odds of LP. CONCLUSIONS Provider initiated testing was the only variable to increase the odds of late presentation. Since the patients in this sample all self-identified as heterosexual, it appears that providers are not requesting they be tested for HIV until the patients are already presenting symptoms of AIDS. The high prevalence of late presentation provides additional evidence to shift towards routine testing and linkage to care, rather than risk-based strategies that may not effectively or efficiently engage individuals infected with HIV.
Collapse
Affiliation(s)
| | | | - Manasa Reddy
- The Miriam Hospital. Alpert Medical School of Brown University. Rhode Island, USA
| | - Amy Nunn
- School of Public Health of Brown University. Rhode Island, USA
| | - Inês Dourado
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| |
Collapse
|
19
|
Waldrop G, Doherty M, Vitoria M, Ford N. Stable patients and patients with advanced disease: consensus definitions to support sustained scale up of antiretroviral therapy. Trop Med Int Health 2016; 21:1124-30. [PMID: 27371814 DOI: 10.1111/tmi.12746] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE As guidelines are evolving towards recommending starting antiretroviral therapy (ART) in all HIV-positive individuals irrespective of clinical and immunological status, HIV programmes will be challenged to manage an increasingly diverse set of patient needs. To support global guideline recommendations for differentiated service delivery, WHO developed consensus definitions for two distinct patient populations: patients presenting with advanced disease and patients who are stable on ART. METHODS An expert panel consisting of 73 respondents from 28 countries across all six WHO regions supported the development of these definitions. The panel included clinicians, researchers, programme managers, technical advisors and patient group representatives. RESULTS Patients presenting with advanced disease at presentation to care were defined as CD4 count <200 CD4 cells/mm(3) or WHO Stage III & IV defining illness. Patients stable on ART were defined as those who were receiving ART for at least 1 year with no adverse drug reactions requiring regular monitoring, no current illnesses or pregnancy, a good understanding of lifelong adherence, and evidence of treatment success. Treatment success was defined as two consecutive undetectable viral load measures or, in the absence of viral load monitoring, rising CD4 counts or CD4 counts above 200 cells/mm(3) and an objective adherence measure. CONCLUSIONS Patients who are stable on ART should be offered a less intensive care package that can lead to improved outcomes while saving resources, including less frequent clinic visits, out-of-clinic drug refills and reduced laboratory monitoring. This will allow for clinic resources to be directed towards reducing morbidity and mortality among patients presenting with advanced disease.
Collapse
Affiliation(s)
- Greer Waldrop
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
| |
Collapse
|
20
|
d’Arminio Monforte A, Cozzi-Lepri A, Maggiolo F, Rizzardini G, Manconi PE, Gianotti N, Quirino T, Pinnetti C, Rusconi S, De Luca A, Antinori A. Response to First-Line Ritonavir-Boosted Protease Inhibitors (PI/r)-Based Regimens in HIV Positive Patients Presenting to Care with Low CD4 Counts: Data from the Icona Foundation Cohort. PLoS One 2016; 11:e0156360. [PMID: 27348592 PMCID: PMC4922579 DOI: 10.1371/journal.pone.0156360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are no data comparing the response to PI/r-based regimens in people presenting for care with low CD4 counts or AIDS (LC). AIM To compare the response to LPV/r-, DRV/r- or ATV/r-based cART regimens in LC initiating cART from ART-naive. METHODS We included people enrolled in Icona with either CD4 counts ≤350 cells/mm3 (low CD4-LC) or CD4 counts ≤200 cells/mm3 (very low CD4-VLC) and/or AIDS, starting their first PI/r-based regimen after 2008. Initial regimens were compared by intention-to-treat: i) time to viral failure (VF) (first of 2 consecutive VL>200 copies/mL after≥6 months); II) time to PI/r discontinuation/switching for any cause (TD) and for toxicity (TDT); III) treatment failure (TF) (VF or TD). Kaplan-Meier and Cox analyses were used. RESULTS 1,362 LC patients were included (DRV/r 607; ATV/r 552; LPV/r 203); 813 VLC. In a median of 18 months (IQR:7-35), the 1-year probability of VF and TF were 2.8% (1.9-3.8) and 21.1% (18.7-23.4). In the adjusted analysis, patients initiating ATV/r had a 53% lower chance, and those initiating DRV/r a 61% lower chance of TD, as compared to LPV/r; the risk of TF was more likely in people starting LPV/r. Results were similar among VLC; in this subgroup LPV/r including regimens demonstrated a lower chance of VF. CONCLUSIONS We confirmed in LC a low chance of virological failure by 1 year, with small differences according to PI/r. However, larger differences were observed when comparing longer-term endpoints such as treatment failure. These results are important for people presenting late for care.
Collapse
Affiliation(s)
- Antonella d’Arminio Monforte
- University of Milan, Department of Health Sciences, Clinic of Infectious and Tropical Diseases, ASST Santi Paolo e Carlo, Milan, Italy
- * E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Nasta P, Salmon D, d'Arminio Monforte A, Pimenta JM, Cerini C, Giralda M, Winnock M, Cozzi-Lepri A. Fosamprenavir/ritonavir in patients with viral hepatitis coinfection: an observational multicohort study. HIV CLINICAL TRIALS 2016; 17:96-108. [PMID: 27125364 DOI: 10.1080/15284336.2016.1150409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Safety and tolerability evaluation of adapted dose regimens containing fosamprenavir/ritonavir (FPV/r) in HIV-infected subjects with viral hepatitis co-infection. METHODS A retrospective multicohort analysis was conducted. Subjects from three European cohorts who started FPV/r or lopinavir/ritonavir (LPV/r) as a comparator contributed data to a centralized database. Subjects were divided into five groups by treatment regimen and level of hepatic impairment (aspartate aminotransferase [AST] platelet ratio index [APRI] score < or ≥2). Multivariable Cox regression analyses controlling for demographic factors, baseline CD4 count, FIB-4 score, use of antiretroviral therapy, and laboratory markers (bilirubin and platelet count) were performed to identify factors independently associated with risk of developing adverse events or safety events (eg, drug discontinuation, alanine aminotransferase (ALT) elevation, hepatic decompensation/death). RESULTS A total of 1096 patients contributed data to the study. Fosamprenavir/ritonavir (except in subjects with APRI ≥2 receiving standard dose) was associated with a higher two-year risk of drug discontinuation compared with LPV/r. Restricting the analysis to discontinuations due to adverse events (AEs), only subjects who received the reduced dose were more likely to discontinue ≥1 drug in the FPV/r regimen. There were no statistical differences in ALT elevation between groups. Incidence of hepatic decompensation events was similar among groups except for subjects who received non standard doses of FPV, though the number of events was small. CONCLUSIONS Fosamprenavir/ritonavir discontinuation rate due to AEs or ALT elevation was similar across all European-approved FPV/r doses and to that of LPV/r subjects. Although liver tolerated antiretrovirals, such as integrase inhibitor and entry inhibitor, the use of FPV/r is acceptable in HIV infected patients with viral hepatitis.
Collapse
Affiliation(s)
- Paola Nasta
- a University Division of Infectious and Tropical Diseases , University of Brescia and Spedali Civili General Hospital, Spedali Civili Hospital , Brescia , Italy
| | - Dominique Salmon
- b Service des Maladies Infectieuses et Tropicales, Hôpital Cochin , APHP-Université Paris Descartes , Paris , France
| | - Antonella d'Arminio Monforte
- c Infectious Diseases Unit, Department of Health Sciences , ASST Santi Paolo e Carlo University Hospital , Milan , Italy
| | | | - Carlo Cerini
- a University Division of Infectious and Tropical Diseases , University of Brescia and Spedali Civili General Hospital, Spedali Civili Hospital , Brescia , Italy
| | - Mariarosaria Giralda
- a University Division of Infectious and Tropical Diseases , University of Brescia and Spedali Civili General Hospital, Spedali Civili Hospital , Brescia , Italy
| | - Maria Winnock
- e ISPED , Université Bordeaux , F33000 Bordeaux , France.,f INSERM, Centre INSERM U897 , Bordeaux , France
| | - Alessandro Cozzi-Lepri
- g Research Department of Infection and Population Health , University College London , London , UK
| |
Collapse
|
22
|
Sobrino-Vegas P, Moreno S, Rubio R, Viciana P, Bernardino JI, Blanco JR, Bernal E, Asensi V, Pulido F, del Amo J, Hernando V. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004-2013. J Infect 2016; 72:587-96. [PMID: 26920789 DOI: 10.1016/j.jinf.2016.01.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). METHODS Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. RESULTS Of 7165 new HIV diagnoses, 46.9% (CI95%:45.7-48.0) were LP, 240 patients died. First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5-19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2-3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7-3.1). First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004-05) to 39.4% (2012-13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women. Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2-1.7]); age (OR31-40.vs.<30 = 1.6[1.4-1.8], OR41-50.vs.<30 = 2.2[1.8-2.6], OR>50.vs.<30 = 3.6[2.9-4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0-3.8]; ORHeterosexual.vs.MSM = 2.2[1.7-3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1-2.0], ORLowerSecondary.vs.University = 1.3[1.1-1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3-2.0], ORLatin-American.vs.Spain = 1.4[1.2-1.8]). CONCLUSIONS LP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women.
Collapse
Affiliation(s)
- Paz Sobrino-Vegas
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | | | - Rafael Rubio
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | | | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Julia del Amo
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Victoria Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
23
|
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
|
24
|
Cingolani A, Zona S, Girardi E, Cozzi-Lepri A, Monno L, Quiros Roldan E, Guaraldi G, Antinori A, D’Arminio Monforte A, Marcotullio S. Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort. HIV Med 2015; 16:412-20. [PMID: 25959419 PMCID: PMC4682467 DOI: 10.1111/hiv.12226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis. METHODS All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors. RESULTS Data for 9168 participants were analysed [median age 37.3 (range 18-81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0-22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52-3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42-1.97 for 2008-2012 versus 1998-2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19-1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69-5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77-0.89) and being currently on ART (RR 0.38; 95% CI 0.33-0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs. CONCLUSIONS An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.
Collapse
Affiliation(s)
- A Cingolani
- Department of Public Health, Infectious Diseases, Catholic UniversityRome, Italy
| | - S Zona
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio EmiliaModena, Italy
| | - E Girardi
- Department of Epidemiology, National Institute for Infectious Diseases ‘L. Spallanzani’Rome, Italy
| | - A Cozzi-Lepri
- Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free CampusLondon, UK
| | - L Monno
- Institute of Infectious Diseases, University of BariBari, Italy
| | - E Quiros Roldan
- Institute of Infectious Diseases, University of BresciaBrescia, Italy
| | - G Guaraldi
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio EmiliaModena, Italy
| | - A Antinori
- Clinical Department, National Institute for Infectious Diseases ‘L. Spallanzani’Rome, Italy
| | - A D’Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University HospitalMilan, Italy
| | | |
Collapse
|
25
|
Romero-Severson EO, Lee Petrie C, Ionides E, Albert J, Leitner T. Trends of HIV-1 incidence with credible intervals in Sweden 2002-09 reconstructed using a dynamic model of within-patient IgG growth. Int J Epidemiol 2015; 44:998-1006. [PMID: 26163684 DOI: 10.1093/ije/dyv034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND HIV-1 is a lifelong disease, often without serious symptoms for years after infection, and thus many infected persons go undetected for a long time. This makes it difficult to track incidence, and thus epidemics may go through dramatic changes largely unnoticed, only to be detected years later. Because direct measurement of incidence is expensive and difficult, several biomarker-based tests and algorithms have been developed to distinguish between recent and long-term infections. However, current methods have been criticized and demands for novel methods have been raised. METHODS We developed and applied a biomarker-based incidence model, joining a time-continuous model of immunoglobulin G (IgG) growth (measured by the IgG-capture BED-enzyme immunoassay) with statistical corrections for both sample size and unobserved diagnoses. Our method uses measurements of IgG concentration in newly diagnosed people to calculate the posterior distribution of infection times. Time from infection to diagnosis is modelled for all individuals in a given period and is used to calculate a sample weight to correct for undiagnosed individuals. We then used a bootstrapping method to reconstruct point estimates and credible intervals of the incidence of HIV-1 in Sweden based on a sample of newly diagnosed people. RESULTS We found evidence for: (i) a slowly but steadily increasing trend in both the incidence and incidence rate in Sweden; and (ii) an increasing but well-controlled epidemic in gay men in Stockholm. Sensitivity analyses showed that our method was robust to realistic levels (up to 15%) of BED misclassification of non-recently infected persons as early infections. CONCLUSIONS We developed a novel incidence estimator based on previously published theoretical work that has the potential to provide rapid, up-to-date estimates of HIV-1 incidence in populations where BED test data are available.
Collapse
Affiliation(s)
| | - Cody Lee Petrie
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Edward Ionides
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA and
| | - Jan Albert
- Departments of Microbiology, Karolinska Institute and Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Leitner
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| |
Collapse
|
26
|
Temporal trends of time to antiretroviral treatment initiation, interruption and modification: examination of patients diagnosed with advanced HIV in Australia. J Int AIDS Soc 2015; 18:19463. [PMID: 25865372 PMCID: PMC4394156 DOI: 10.7448/ias.18.1.19463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 02/17/2015] [Accepted: 03/04/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Methods We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Results Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural–regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007–2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007–2012 versus 1996–2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Conclusions Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.
Collapse
|
27
|
Kittner JM, von Bialy L, Wiltink J, Thomaidis T, Gospodinov B, Rieke A, Katz F, Discher T, Rath K, Claus B, Held G, Friese G, Schappert B, Schuchmann M, Galle PR. Lack of awareness in both patients and physicians contributes to a high rate of late presentation in a South West German HIV patient cohort. Infection 2015; 43:299-305. [PMID: 25600928 DOI: 10.1007/s15010-014-0719-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/31/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess rate of late presentation with HIV in Southwestern Germany and to identify patient characteristics correlated with CD4 nadir. METHODS Patients with primary diagnosis who presented to one of ten participating clinics rated on knowledge and behavior towards HIV testing on a self-developed questionnaire, whereas clinical data was assessed by the physician. RESULTS 161 patients were included. Risk factors were homosexual (59.5 %) or heterosexual contacts (26.8 %), drug use (2.0 %), migration (3.9 %), or others (7.8 %). 63.5 % had a CD4 T cell count < 350/µl. 52.5, 17.4, and 31.1 % were diagnosed in CDC stadium A, B or C, respectively. 209 disease episodes were reported, from whom 83.7 % had led to the diagnosis of HIV. 75.2 and 68.3 % said to have been well-informed about ways of transmission and testing offerings, respectively, and 20.4 % admitted to have psychologically repressed the possibility of being infected. 48 patients rated their personal behavioral risk as "high" or "very high". Of these, however, only ten had performed at test in the precedent year. Performing a regression analysis, younger age and previous testing were correlated with a higher CD4 T cell nadir (p = 0.005, and 0.018, resp.). CONCLUSION The rate of late presentation in this region was even higher compared to national or European surveys. Most infected patients perceived to have had only a low risk. Several disease episodes did not lead to the initiation of HIV testing by the physician.
Collapse
Affiliation(s)
- J M Kittner
- 1st Medical Department, University Medical Centre Mainz, Langenbeckstr. 1, 55131, Mainz, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
MacCarthy S, Brignol S, Reddy M, Nunn A, Dourado I. Making the invisible, visible: a cross-sectional study of late presentation to HIV/AIDS services among men who have sex with men from a large urban center of Brazil. BMC Public Health 2014; 14:1313. [PMID: 25535408 PMCID: PMC4364329 DOI: 10.1186/1471-2458-14-1313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background Late presentation to testing, treatment and continued care has detrimental impacts on the health of HIV-positive individuals as well as their sexual partners’ health. Men who have sex with men (MSM) experience disproportionately high rates of HIV both globally and in Brazil. However, the factors that inhibit linkage to care among MSM remain unclear. Methods We conducted a cross-sectional study of HIV-positive MSM (n = 740) enrolled in HIV/AIDS services in a large urban center of Brazil from August 2010 to June 2011. Descriptive, bivariate and multivariate statistics were conducted using STATA 12 to examine the relationship between a range of variables and late presentation, defined as having a first CD4 count <350 cells/mm3. Results Within the sample, the prevalence of LP was 63.1%. Men who self-identified as heterosexual (AOR 1.54 and 95% CI 1.08 - 2.20) compared to men who self-identified as homosexual and bisexual were at increased odds of late presentation. Additionally, men age 30 and older (AOR 1.56, 95% CI 1.01 – 2.43) compared to individuals age 18–29 experienced increased odds of late presentation among MSM. Conclusions The prevalence of LP in this population was higher than noted in the global literature on LP among MSM. Heterosexual men and older age individuals experienced substantial barriers to HIV care. The stigma around same-sex behaviors and the current focus of HIV prevention and treatment campaigns on younger age individuals may limit patients’ and providers’ awareness of the risk for HIV and access to available services. In addition to addressing HIV-specific barriers to care, developing effective strategies to reduce late presentation in Brazil will require addressing social factors - such as stigma against diverse sexualities - to concretely identify and eliminate barriers to available services. Only in so doing can we make currently invisible people, visible.
Collapse
Affiliation(s)
- Sarah MacCarthy
- Rand Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | | | | | | | | |
Collapse
|
29
|
Moniuszko M, Moniuszko A, Puciłowska J, Kisluk K, Jeznach M, Grzeszczuk A, Flisiak R, Bodzenta-Lukaszyk A. Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report. J Med Case Rep 2014; 8:104. [PMID: 24666756 PMCID: PMC3978083 DOI: 10.1186/1752-1947-8-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/23/2014] [Indexed: 11/10/2022] Open
|
30
|
Widgren K, Skar H, Berglund T, Kling AM, Tegnell A, Albert J. Delayed HIV diagnosis common in Sweden, 2003-2010. ACTA ACUST UNITED AC 2014; 46:862-7. [PMID: 25290584 PMCID: PMC4266095 DOI: 10.3109/00365548.2014.953575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Early diagnosis of HIV is important for the prognosis of individual patients, because antiretroviral treatment can be started at the appropriate time, and for public health, because transmission can be prevented. Methods Data were collected from 767 HIV patients who were diagnosed in Sweden during 2003–2010 and were infected in Sweden or born in Sweden and infected abroad. A recent infection testing algorithm (RITA) was applied to BED-EIA test results (OD-n < 0.8), CD4 counts (≥ 200 cells/μl), and clinical information. A recent infection classification was used as indicator for early diagnosis. Time trends in early diagnosis were investigated to detect population changes in HIV testing behavior. Patients with early diagnosis were compared to patients with delayed diagnosis with respect to age, gender, transmission route, and country of infection (Sweden or abroad). Results Early diagnosis was observed in 271 patients (35%). There was no statistically significant time trend in the yearly percentage of patients with early diagnosis in the entire study group (p = 0.836) or in subgroups. Early diagnosis was significantly more common in men who have sex men (MSM) (45%) than in heterosexuals (21%) and injecting drug users (27%) (p < 0.001 and p = 0.001, respectively) in both univariate and multivariable analyses. The only other factor that remained associated with early diagnosis in multivariable analysis was young age group. Conclusion Approximately one-third of the study patients were diagnosed early with no significant change over time. Delayed HIV diagnosis is a considerable problem in Sweden, which does not appear to diminish.
Collapse
Affiliation(s)
- Katarina Widgren
- From the 1 Department for Monitoring and Evaluation, Public Health Agency of Sweden , Solna , Sweden *
| | | | | | | | | | | |
Collapse
|
31
|
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
|
32
|
[Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)]. Enferm Infecc Microbiol Clin 2014; 33:173-80. [PMID: 25027695 DOI: 10.1016/j.eimc.2014.04.012] [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: 06/05/2013] [Revised: 03/18/2014] [Accepted: 04/16/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (<2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies.
Collapse
|
33
|
Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000-2010. Infection 2014; 42:859-67. [PMID: 24973981 DOI: 10.1007/s15010-014-0648-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/11/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Migrants account for approximately 8.7% of the resident population in Italy. The immigration status deeply influences access to prevention and care, thus contributing to increase the burden of HIV/AIDS among such a fragile category. The aim of this study was to investigate socio-demographic and baseline clinical and immunological features of HIV-infected migrants, as compared to Italians. METHODS We retrospectively analysed data for all the 1,611 HIV-infected migrant patients and a random sample of 4,230 HIV-infected Italian patients aged 18 or older who first accessed nine Italian clinical centres in 2000-2010 and were followed up at least 1 year. Differences in baseline characteristics between migrants and Italians were evaluated in univariate analysis, while factors associated with late presentation were evaluated in multivariate analysis using logistic regression models. RESULTS The baseline profile differs between the HIV-infected migrant and Italian patients, substantially reflecting what reported by current statistics in terms of gender, age, risk category as well as clinical features. Late presenters were more frequent among migrants as compared to Italians (53.0 vs 45.8%; adjusted odds ratio [(AOR) = 1.55, 95% confidence interval (CI) 1.34-1.78]. Other factors associated with late presentation included increasing age, as well as undocumented legal status among foreign-born subjects (AOR = 1.41, 95% CI 0.97-2.04), though of borderline significance. CONCLUSIONS Late presentation still represents a relevant problem despite the advances in the management of HIV infection. More efforts are needed to allow early diagnosis and access to care among the most vulnerable, such as undocumented foreign-born subjects in a country where migration flows are on the rise.
Collapse
|
34
|
Cingolani A, Cozzi-Lepri A, Ammassari A, Mussini C, Ursitti MA, Caramello P, Angarano G, Bonfanti P, De Luca A, Mura MS, Girardi E, Antinori A, Monforte AD. Timing of antiretroviral therapy initiation after a first AIDS-defining event: temporal changes in clinical attitudes in the ICONA cohort. PLoS One 2014; 9:e89861. [PMID: 24587081 PMCID: PMC3937396 DOI: 10.1371/journal.pone.0089861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/25/2014] [Indexed: 11/18/2022] Open
Abstract
Background Time of starting antiretroviral therapy (ART) after diagnosis of specific AIDS-defining event (ADE) is a crucial aspect. Objectives of this study were to evaluate if in patients diagnosed with ADE the time to ART initiation may vary according to year of diagnosis and type of ADE. Methods All HIV+ persons diagnosed with an ADE over the 6 months prior to or after enrolment in the Icona Foundation study cohort and while ART-naive were grouped according to type of diagnosis: Those with ADE requiring medications interacting with ART [group A], those with ADE treatable only with ART [B] and other ADE [C]. Survival analysis by Kaplan-Meier was used to estimate the percentage of people starting ART, overall and after stratification for calendar period and ADE group. Multivariable Cox regression model was used to investigate association between calendar year of specific ADE and time to ART initiation. Results 720 persons with first ADE were observed over 1996–2013 (group A, n = 171; B, n = 115; C, n = 434). By 30 days from diagnosis, 27% (95% CI: 22–32) of those diagnosed in 1996–2000 had started ART vs. 32% (95% CI: 24–40) in 2001–2008 and 43% (95% CI: 33–47) after 2008 (log-rank p = 0.001). The proportion of patients starting ART by 30 days was 13% (95% CI 7–19), 40% (95% CI: 30–50) and 38% (95% CI 33–43) in ADE groups A, B and C (log-rank p = 0.0001). After adjustment for potential confounders, people diagnosed after 2008 remained at increased probability of starting ART more promptly than those diagnosed in 1996–1999 (AHR 1.72 (95% CI 1.16–2.56). Conclusions In our “real-life” setting, the time from ADE to ART initiation was significantly shorter in people diagnosed in more recent years, although perhaps less prompt than expected.
Collapse
Affiliation(s)
- Antonella Cingolani
- Department of Public Health, Institute of Infectious Diseases, Catholic University, Roma, Italy
- * E-mail:
| | - Alessandro Cozzi-Lepri
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Adriana Ammassari
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani,” Roma, Italy
| | - Cristina Mussini
- Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Pietro Caramello
- Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Andrea De Luca
- Department of Internal and Specialty Medicine, University Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Stella Mura
- Department of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Enrico Girardi
- Department of Epidemiology, National Institute for Infectious Diseases “L. Spallanzani,” Roma, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases “L. Spallanzani,” Roma, Italy
| | - Antonela D'Arminio Monforte
- Department of Medicine, Surgery and Dentistry University of Milan Clinic of Infectious Diseases, “San Paolo” Hospital, Milan, Italy
| | | |
Collapse
|
35
|
Agaba PA, Meloni ST, Sule HM, Agbaji OO, Ekeh PN, Job GC, Nyango N, Ugoagwu PO, Imade GE, Idoko JA, Kanki PJ. Patients who present late to HIV care and associated risk factors in Nigeria. HIV Med 2014; 15:396-405. [PMID: 24580742 DOI: 10.1111/hiv.12125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. METHODS We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. RESULTS Among 14,487 eligible patients, 12,401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). CONCLUSIONS Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.
Collapse
Affiliation(s)
- P A Agaba
- Department of Family Medicine, University of Jos, Jos, Nigeria; AIDS Prevention Initiative Nigeria Plus, Jos University Teaching Hospital, Jos, Nigeria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Yombi JC, Jonckheere S, Vincent A, Wilmes D, Vandercam B, Belkhir L. Late presentation for human immunodeficiency virus HIV diagnosis results of a Belgian single centre. Acta Clin Belg 2014; 69:33-9. [PMID: 24635397 DOI: 10.1179/0001551213z.00000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antiretroviral therapy reduces mortality and morbidity in HIVinfected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. Although the international guidelines recommend starting antiretroviral therapy ART with a high CD4 cell count level, in the practice, this is particularly challenging to achieve, especially in late presentation of HIV diagnosis. The aim of this study was to determine the frequency and the demographic features associated with late presentation for HIV diagnosis in our Centre. METHODS All newly diagnosed patients with HIV between January 2007 and December 2011 in our AIDS Reference Centre, were included. Late presenter patient was defined as patient with CD4 count 350/mm(3) at the time of diagnosis. Demographic age, sex, ethnicity, migration and clinical characteristics transmission mode, CD4 cell count, viral load were collected. We also collected data on outcome median day of hospitalization, mortality, virological response to ART and lost to followup LTFU. LTFU was defined as patient without any medical contact and viral load measurements during two consecutive years in our centre. RESULTS From 2007 to 2011, 154 429 out of 359 patients newly diagnosed with HIV were late presenters. According to univariate analysis, age 50, female gender, migrant from subSaharan Africa and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, age 50, heterosexual contact and migrant status particularly women were the only independent risk factors for late presentation. Late presenters tend to have a worse outcome than nonlate presenters. CONCLUSION A considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been clearly identified. Despite high testing rate for HIV in Belgium, highrisk population like migrant, heterosexual contact, remain under tested. In order to be able to detect and treat all patients with high CD4 cell count as recommended by all international guidelines, we recommend developing testing policies specifically focused on these categories at high risk for late presentation.
Collapse
|
37
|
Impact of late presentation on the risk of death among HIV-infected people in France (2003-2009). J Acquir Immune Defic Syndr 2013; 64:197-203. [PMID: 24047970 DOI: 10.1097/qai.0b013e31829cfbfa] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A recent consensus defines "late presentation" (LP) during the course of HIV infection as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells per cubic millimeter. Here, using this new definition, we examined the frequency and predictors of LP and its impact on mortality. METHODS In antiretroviral-naive patients enrolled in the French Hospital Database on HIV between 2003 and 2009, we studied risk factors for LP by multivariable logistic regression. The impact of LP on mortality was analyzed according to the level of immunodeficiency by using Cox multivariable models adjusted for potential confounders, with follow-up categorized into 0-6, 6-12, and 12-48 months. RESULTS There were 11,038 (53.9%) late presenters among the 20,496 patients included in the study. Compared with patients presenting for care with CD4 ≥350 cells per cubic millimeter, patients presenting with AIDS had a very high risk of death with crude hazard ratio ranging from 48.3 during the first 6 months of follow-up to 4.8 during months 12-48; the corresponding values among AIDS-free patients with CD4 ≤200 cells per cubic millimeter were 8.1 and 2.3. Importantly, patients presenting with CD4 between 200 and 350 cells per cubic millimeter also had a significantly increased risk of death beyond 6 months of follow-up (hazard ratio: 3.0 and 1.8 for months 6-12 and 12-48, respectively). Results were similar after adjustment. CONCLUSIONS LP with HIV infection is still very frequent in France and is associated with higher mortality, even among patients with only moderate immunodeficiency. Encouraging early testing and access to care is still urgently needed.
Collapse
|
38
|
Lesko CR, Cole SR, Zinski A, Poole C, Mugavero MJ. A Systematic Review and Meta-regression of Temporal Trends in Adult CD4+ Cell Count at Presentation to HIV Care, 1992-2011. Clin Infect Dis 2013; 57:1027-37. [DOI: 10.1093/cid/cit421] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
39
|
Analysis of risk factors for late presentation in a cohort of HIV-infected patients in Dresden: positive serology for syphilis in MSM is a determinant for earlier HIV diagnosis. Infection 2013; 41:1145-55. [DOI: 10.1007/s15010-013-0476-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
|
40
|
Skar H, Albert J, Leitner T. Towards estimation of HIV-1 date of infection: a time-continuous IgG-model shows that seroconversion does not occur at the midpoint between negative and positive tests. PLoS One 2013; 8:e60906. [PMID: 23613753 PMCID: PMC3628711 DOI: 10.1371/journal.pone.0060906] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Estimating date of infection for HIV-1-infected patients is vital for disease tracking and informed public health decisions, but is difficult to obtain because most patients have an established infection of unknown duration at diagnosis. Previous studies have used HIV-1-specific immunoglobulin G (IgG) levels as measured by the IgG capture BED enzyme immunoassay (BED assay) to indicate if a patient was infected recently, but a time-continuous model has not been available. Therefore, we developed a logistic model of IgG production over time. We used previously published metadata from 792 patients for whom the HIV-1-specific IgG levels had been longitudinally measured using the BED assay. To account for patient variability, we used mixed effects modeling to estimate general population parameters. The typical patient IgG production rate was estimated at r = 6.72[approximate 95% CI 6.17,7.33]×10−3 OD-n units day−1, and the carrying capacity at K = 1.84[1.75,1.95] OD-n units, predicting how recently patients seroconverted in the interval ∧t = (31,711) days. Final model selection and validation was performed on new BED data from a population of 819 Swedish HIV-1 patients diagnosed in 2002–2010. On an appropriate subset of 350 patients, the best model parameterization had an accuracy of 94% finding a realistic seroconversion date. We found that seroconversion on average is at the midpoint between last negative and first positive HIV-1 test for patients diagnosed in prospective/cohort studies such as those included in the training dataset. In contrast, seroconversion is strongly skewed towards the first positive sample for patients identified by regular public health diagnostic testing as illustrated in the validation dataset. Our model opens the door to more accurate estimates of date of infection for HIV-1 patients, which may facilitate a better understanding of HIV-1 epidemiology on a population level and individualized prevention, such as guidance during contact tracing.
Collapse
Affiliation(s)
- Helena Skar
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Leitner
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- * E-mail:
| |
Collapse
|
41
|
Camoni L, Raimondo M, Regine V, Salfa MC, Suligoi B. Late presenters among persons with a new HIV diagnosis in Italy, 2010-2011. BMC Public Health 2013; 13:281. [PMID: 23537210 PMCID: PMC3616982 DOI: 10.1186/1471-2458-13-281] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010-2011. METHODS We used individual data on new HIV diagnoses reported by the HIV surveillance system in 2010 and in 2011. Persons with CD4 ≤350 cells/μL or diagnosed with AIDS (regardless of the CD4 cell count) were defined as late presenters (LP); persons with CD4 ≤ 200 cells/μL or AIDS (regardless of the CD4 cell count) were defined as presenting with advanced HIV disease (AHD). RESULTS Of the 7,300 new diagnoses reported in 2010-2011 by the included regions, 55.2% were LP; among these, 37.9% was diagnosed with AIDS. Persons presenting with AHD were 37.8%. The median age of LP was 40 years (IQR 33-48), significantly higher (p < 0.001) than that of non-LP (35 years); 73.9% were males; 30.7% were non-nationals. The median age of AHD was 42 years (IQR 35-50), 74.5% were males; 31.1% were non-nationals. The proportion of LP among IDUs was 59.8%, among heterosexuals (HET) 61.1% and among MSM 44.3%. The proportion of AHD among IDUs was 43.6%, among HET 43.2% and among MSM 27.4%. Factors significantly associated with being LP were: age older than 50 years (OR = 4.6 [95% CI 3.8-5.6]); having been diagnosed in Southern Italy (Southern vs Northern Italy OR = 1.5 [95% CI 1.3-1.7]) having been diagnosed in Central Italy (Central vs Northern Italy OR = 1.3 [95% CI 1.1-1.6]); being HET (HET vs MSM, OR = 1.7 [95% CI 1.5-2.0]), being non-national (Non-national vs Italian, OR 1.7 (95% CI 1.5-2.0); being IDU (IDU vs MSM, OR = 1.6 [95% CI 1.2-2.1]). The same factors were significantly associated with being AHD. CONCLUSIONS Older people, people diagnosed in Central and Southern Italy, non nationals, and persons who acquired the infection through injecting drug use or heterosexual contact showed a higher risk of being diagnosed late. A more active offer of HIV testing and targeted interventions focussed on these populations are needed to optimize early access to care and treatment.
Collapse
Affiliation(s)
- Laura Camoni
- AIDS Unit, Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
42
|
Late presentation of HIV despite earlier opportunities for detection, experience from an Irish tertiary referral institution. Ir J Med Sci 2013; 182:389-94. [PMID: 23322091 DOI: 10.1007/s11845-012-0898-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Late presentation of HIV continues to undermine advances in the management of HIV. Opportunities to detect HIV at an earlier stage are often missed. Current estimates suggest that undiagnosed individuals comprise approximately one quarter of all people in the western world living with HIV. 'Testing-and-treating' this group has been proposed as a means to curb the HIV epidemic. In this study we assessed the characteristics of individuals newly diagnosed with HIV, and their utilisation of healthcare services in Ireland prior to their diagnosis. METHODS A retrospective review was undertaken of all patients newly diagnosed with HIV over a 27-month period. Patient demographics were recorded, as were details of healthcare contacts in the year preceding diagnosis. Individuals detected via screening of recent immigrants/asylum seekers were excluded. RESULTS In the period studied 114 patients received a new diagnosis of HIV, 59 met inclusion criteria. The majority (54%) fulfilled the European consensus definition for late presenters (CD4<350 cells/µl). 'Late presenters' were significantly more likely to be symptomatic at diagnosis (OR=4.62; 95% CI 1.45-14.67; p=0.015), diagnosed by acute tertiary hospital services (p=0.015), and 56% reported heterosexual mode of acquisition (OR=2.12; 95% CI 0.73-6.16; p=0.19). Patients detected via screening had significantly higher CD4 counts at diagnosis compared with those diagnosed due to symptoms (Median CD4 422 cells/µl; IQR 285-594 vs. 142 cells/µl; IQR 62-333; p=0.0007). 'Symptomatic' patients were significantly more likely to report prior healthcare contacts (OR 4.71; 95 % CI 1.32-16.79; p=0.013). CONCLUSION Current screening activities are inadequate. Unfortunately newly diagnosed HIV patients continue to be symptomatic, at advanced stages of disease, to acute hospital services. Heterosexual groups in particular are at risk for late detection.
Collapse
|
43
|
Mocroft A, Lundgren JD, Sabin ML, Monforte AD, Brockmeyer N, Casabona J, Castagna A, Costagliola D, Dabis F, De Wit S, Fätkenheuer G, Furrer H, Johnson AM, Lazanas MK, Leport C, Moreno S, Obel N, Post FA, Reekie J, Reiss P, Sabin C, Skaletz-Rorowski A, Suarez-Lozano I, Torti C, Warszawski J, Zangerle R, Fabre-Colin C, Kjaer J, Chene G, Grarup J, Kirk O. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med 2013; 10:e1001510. [PMID: 24137103 PMCID: PMC3796947 DOI: 10.1371/journal.pmed.1001510] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. METHODS AND FINDINGS LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm(3) or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95-0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19-20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55-12.43). CONCLUSIONS LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.
Collapse
Affiliation(s)
- Amanda Mocroft
- Department of Infection and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Jens D. Lundgren
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | | | | | - Norbert Brockmeyer
- Department of Dermatology, Venerology, and Allergology, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Jordi Casabona
- CEEISCAT (Agència de Salut Pública de Catalunya) and CIBERESP, Badalona, Catalonia, Spain
| | | | | | - Francois Dabis
- Université of Bordeaux, ISPED, Centre Inserm, U897–Epidémiologie–Biostatistiques, Bordeaux, France
- Inserm U897–Epidémiologie–Biostatistiques, Bordeaux, France
| | | | | | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anne M. Johnson
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Marios K. Lazanas
- 3rd Internal Medicine Department and Infectious Disease Unit, Red Cross General Hospital of Athens, Greece
| | - Catherine Leport
- Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France
- INSERM, UMR 738, Paris, France
| | - Santiago Moreno
- Department of Infectious Diseases. University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Frank A. Post
- Kings College London School of Medicine, London, United Kingdom
| | - Joanne Reekie
- Department of Infection and Population Health, University College London, London, United Kingdom
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Caroline Sabin
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Adriane Skaletz-Rorowski
- German Competence Network for HIV/AIDS, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Ignacio Suarez-Lozano
- Infectious Diseases Unit, Complejo Hospitalario de Huelva, Spanish VACH Cohort, Spain
| | - Carlo Torti
- University Division of Infectious and Tropical Diseases, University and Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Sciences, Unit of Infectious Diseases, University “Magna Graecia,” Catanzaro, Italy
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Sud, AP-HP Public Health Department, Le Kremlin-Bicêtre, France
| | | | - Céline Fabre-Colin
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
| | - Jesper Kjaer
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
| | - Genevieve Chene
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
| | - Jesper Grarup
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | | |
Collapse
|