Economic burden of late presentation in HIV disease in Austria: a comparison of the initial costs imposed by advanced HIV disease vs. non-late presentation

Abstract Background South Africa has the biggest HIV epidemic in the world, with an estimated 7.1million people living with HIV in 2018. In 2016, women aged 15-24 contributed 37% of new infections. Poverty, low status, gender-based violence (GBV) and intergenerational relationships possibly contribute to this disparate HIV prevalence. The objective of this study was to describe very advanced HIV disease (CD4< count <100cells/µL) amongst 15-24 year old females by interrogating routine laboratory CD4 data. Methods Specimen level CD4 laboratory data of female patients aged 15-24 was extracted for the 2019 calendar year. Patients were categorized as adolescents (15-19) or young women (20-24), in age categories of (i) 15-16, (ii) 17-19, (iii) 20-21 and (iv) 22-24 years. Frequency tables were used to report test volumes and the percentage of samples with counts <100 cells/µl. Results Amongst 259 088 CD4 outcomes extracted, 5.4% of samples had counts <100 cells/µl, with 75.4% of samples from young women and 24.6% from adolescents. Most samples reported an age between 22-24 (52.2%), with the lowest proportion (5.8%) noted in 15-16 year olds. Median CD4 was 485 cells/µL, with medians of 490 and 470 cells/µl noted for young women and adolescents respectively. Review of the <100 cells/µl group revealed a median of 43 cells/µL, with 38 and 46 cells/µL reported for young women and adolescents respectively. There was no significant association between the median CD4 and age category. Very advanced HIV disease by age categories of 15-16, 17-19, 20-21 and 22-24, comprised 7.0%, 5.6%, 5.0% and 5.3% respectively. Conclusions This study demonstrated unacceptable rates of very advanced HIV disease in female adolescents and young women, suggesting HIV seroconversion as teenagers or younger. Evidence-based specific health care interventions for these girls are urgently required, including tailoring social services and health facilities to secure the sexual health of girls and young women. Key messages Very advanced HIV disease presentation in female adolescents is unacceptably high. Young women and adolescents with late presentation.

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Gender difference in advanced HIV disease and late presentation according to European consensus definitions

Scientific Reports ◽

10.1038/srep14543 ◽

2015 ◽

Vol 5 (1) ◽

Cited By ~ 13

Author(s):

Hongbo Jiang ◽

Jieyun Yin ◽

Yunzhou Fan ◽

Jianhua Liu ◽

Zhixia Zhang ◽

...

Keyword(s):

Gender Difference ◽

Late Presentation ◽

Hiv Disease ◽

European Consensus ◽

Advanced Hiv Disease

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“Myocardial inflammatory changes before and after antiretroviral therapy initiation in people with advanced HIV disease”

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa297 ◽

2020 ◽

Author(s):

A Piñeirua-Menéndez ◽

R Flores-Miranda ◽

D Sánchez-Nava ◽

R Ortega-Pérez ◽

P F Belaunzaran-Zamudio ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Late Presentation ◽

Hiv Disease ◽

Cardiovascular Mri ◽

Cd4 Cells ◽

Combined Antiretroviral Therapy ◽

Before And After ◽

Advanced Hiv Disease ◽

Inflammatory Changes ◽

Advanced Immunosuppression

Abstract Because high frequency and late presentation of HIV disease in our population, we decided to explore the presence of myocarditis among people with HIV-infection and advanced immunosuppression (less than 200 CD4+ cells/μL), and to describe the inflammatory changes observed after combined antiretroviral therapy (cART) initiation in an observational, longitudinal, prospective cohort performing cardiovascular MRI (cMRI) and doppler trans-thoracic echocardiogram (TTE).

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The Population Impact of Late Presentation With Advanced HIV Disease and Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin America

American Journal of Epidemiology ◽

10.1093/aje/kwz252 ◽

2019 ◽

Vol 189 (6) ◽

pp. 564-572 ◽

Cited By ~ 2

Author(s):

Pablo F Belaunzarán-Zamudio ◽

Yanink N Caro-Vega ◽

Bryan E Shepherd ◽

Peter F Rebeiro ◽

Brenda E Crabtree-Ramírez ◽

...

Keyword(s):

Latin America ◽

Antiretroviral Therapy ◽

Population Attributable Fraction ◽

Immune Deficiency Syndrome ◽

Late Presentation ◽

Hiv Care ◽

Hiv Disease ◽

Art Initiation ◽

Advanced Hiv Disease ◽

The Impact

Abstract Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001–2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of <200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.

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Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008–2013

BioMed Research International ◽

10.1155/2016/1631878 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Weibin Cheng ◽

Weiming Tang ◽

Zhigang Han ◽

Thitikarn May Tangthanasup ◽

Fei Zhong ◽

...

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

Late Presentation ◽

Infection Prevalence ◽

Hiv Disease ◽

Hiv Diagnosis ◽

Testing Strategies ◽

Prevalence Trends ◽

Advanced Hiv Disease

Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown.Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies.Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (P<0.001); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (P<0.001). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)].Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis.

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Predictors of late presentation and advanced HIV disease among people living with HIV in Oman (2000–2019)

BMC Public Health ◽

10.1186/s12889-021-12048-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ali Elgalib ◽

Samir Shah ◽

Adil Al-Wahaibi ◽

Zeyana Al-Habsi ◽

Maha Al-Fouri ◽

...

Keyword(s):

Logistic Regression ◽

Scale Up ◽

Significant Proportion ◽

Late Presentation ◽

People Living With Hiv ◽

Hiv Disease ◽

Hiv Diagnosis ◽

Targeted Interventions ◽

Male Sex ◽

Advanced Hiv Disease

Abstract Background The aim of this study was to determine the proportions and predictors of late presentation (LP) and advanced HIV disease (AD) in Oman. LP and AD were defined as presenting with a baseline CD4 count of < 350 and < 200 cells/mm3, respectively. Methods We conducted a retrospective database analysis of the National HIV Surveillance System to identify Omani people (≥ 13 years old) who were diagnosed with HIV in the period between January 2000 and December 2019 and had a documented baseline CD4 cell count. We calculated the rates and trend over time of LP and AD. A logistic regression was carried out to determine the predictors of LP and AD. Results A total of 1418 patients, who were diagnosed with HIV in the period from January 2000 to December 2019, were included; 71% were male and 66% were heterosexuals. The median (IQR) age at diagnosis was 33 (25–39) years. Overall, 71% (95% CI: 68–73) and 46% (95% CI: 44–49) of patients had LP and AD at presentation, respectively. The LP percentage decreased from 76% in 2000–2004 to 69% in 2015–2019; AD percentage decreased from 57 to 46% over the same period. The proportions of men with LP and AD were higher than women (74% vs. 62 and 50% vs. 36%, respectively). The percentages of persons with LP among people aged 13–24, 25–49, and ≥ 50 years were 65, 71, and 84%, respectively. The proportions of persons with AD among people aged 13–24, 25–49, and ≥ 50 years were 39, 46, and 65%, respectively. Logistic regression showed that male sex, older age, having an “unknown” HIV risk factor, and living outside Muscat were independent predictors of AD. Male sex also independently predicted LP. Conclusions This analysis indicates that a significant proportion of new HIV cases in Oman continue to present late. This study identified patient subgroups at greatest risk of late HIV diagnosis such as men and older people. Targeted interventions and greater efforts to scale up HIV testing services in Oman are needed.

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Antiretroviral Therapy in Advanced HIV Disease: Which is the Best Regimen?

Aids Reviews ◽

10.24875/aidsrev.m17000010 ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Joaquim Burgos ◽

Esteban Ribera ◽

Vicenç Falcó

Keyword(s):

Antiretroviral Therapy ◽

Hiv Disease ◽

Advanced Hiv Disease

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Fiavobacteriurrt spp. organisms as opportunistic bacterial pathogens during advanced HIV disease

Journal of Infection ◽

10.1016/s0163-4453(99)90007-5 ◽

1999 ◽

Vol 39 (2) ◽

pp. 146-152 ◽

Cited By ~ 22

Author(s):

Roberto Manfredi ◽

Anna Nanetti ◽

Morena Ferri ◽

Antonio Mastroianni ◽

Olga V. Coronado ◽

...

Keyword(s):

Bacterial Pathogens ◽

Hiv Disease ◽

Advanced Hiv Disease

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Combination Therapy With Stavudine and Didanosine in Children With Advanced Human Immunodeficiency Virus Infection: Pharmacokinetic Properties, Safety, and Immunologic and Virologic Effects

PEDIATRICS ◽

10.1542/peds.97.6.886 ◽

1996 ◽

Vol 97 (6) ◽

pp. 886-890

Author(s):

Mark W. Kline ◽

Courtney V. Fletcher ◽

Marianne E. Federici ◽

Alice T. Harris ◽

Kim D. Evans ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Combination Therapy ◽

Lymphocyte Count ◽

Hiv Disease ◽

Hiv Rna ◽

Immunodeficiency Virus ◽

Pharmacokinetic Properties ◽

Cd4 Lymphocyte Count ◽

Cd4 Lymphocyte ◽

Advanced Hiv Disease

Objectives. To obtain preliminary information on the pharmacokinetic properties, tolerance, safety, and antiviral activity of combination therapy with stavudine and didanosine in children with advanced human immunodeficiency virus (HIV) infection. Methods. Eight children (median age, 6.6 years; range, 2.8 to 12 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 42 cells/µL; range, 8 to 553 cells/µL) were treated with stavudine (2 mg/kg per day in two divided doses) and didanosine (180 mg/m2 per day in two divided doses) for 24 weeks. Seven children had histories of prior zidovudine therapy. All children had received stavudine alone for 19 to 33 months before the addition of didanosine to the treatment regimen. Children were assessed clinically and with laboratory studies at baseline, weekly through week 4 of combination therapy, and every 4 weeks thereafter. Results. Analysis of stavudine and didanosine plasma half-life values, clearances, and area under the plasma concentration-versus-time curves revealed no obvious clinical pharmacokinetic interaction between the drugs through study week 12. Combination therapy was well tolerated, and there were no drug-associated clinical or laboratory adverse events. Signs and symptoms of peripheral neuropathy were not observed. All three children with baseline CD4+ lymphocyte counts greater than 50 cells/µL had greater than 20% increases in their counts within the first 12 weeks of therapy; CD4+ lymphocyte count increases were not observed in the other children. Plasma HIV RNA concentrations showed median declines of 0.88 log10 (range, -3.41 log10 to 0.31 log10) and 0.30 log10 (range, -0.63 log10 to 0.89 log10) at study weeks 12 and 24, respectively. Conclusions. Combination therapy with stavudine and didanosine was well tolerated and safe in this small group of children with advanced HIV disease. Plasma HIV RNA concentration declines suggest a favorable effect of therapy on virus load. These findings should be confirmed, and the regimen's clinical efficacy should be examined, in controlled studies of HIV-infected children with less-advanced disease.

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