scholarly journals Assessing late presentation for female adolescents and young women with HIV in 2019, South Africa

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Cassim ◽  
L M Coetzee ◽  
D K Glencross
Keyword(s):  
South Africa ◽  
Social Services ◽  
Young Women ◽  
Laboratory Data ◽  
Intergenerational Relationships ◽  
Late Presentation ◽  
Female Adolescents ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Advanced Hiv Disease

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.

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

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.

scholarly journals Carpal tunnel syndrome in HIV-positive patients coinfected with HCV

Reumatismo ◽  
2017 ◽  
Vol 69 (4) ◽  
pp. 164
Author(s):  
A. Mastroianni ◽  
F. Allegrini ◽  
S. Nardi ◽  
D. Donatucci ◽  
F. Girelli ◽  
...  
Keyword(s):  
General Population ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Age Related ◽  
Rheumatic Manifestations ◽  
Wide Range ◽  
Inflammatory State ◽  
Advanced Hiv Disease ◽  
Living With Hiv

A wide range of rheumatic and peripheral nervous system disorders may develop in patients with HIV infection, leading to pain, sensory symptoms, and muscle weakness. Over the past three decades, the progress in management of HIV disease with anti-retroviral therapy (ART) has resulted in increased life expectancy for people living with HIV disease. With this new chronicity of the disease has a constellation of chronic musculoskeletal, orthopaedic and rheumatic manifestations has emerged, as potential complications of the disease itself and/or the results of ART treatment regimen and/or because of expected age-related symptoms/manifestations. The incidence of CTS in the general population is around 3.8% with clinical examination and, when electroneuromyography is used, it is 2.7%. In the HIV-positive population, the incidence is very close to that of the general population. The aim of this study was to evaluate the incidence of CTS and to identify factors influencing the development of CTS in HIV-infected patients attending our clinic. This syndrome has been associated with advanced HIV disease and the use of ART possibly due to an increased inflammatory state and the presence of concurrent HCV infection.

scholarly journals Trends in CD4 and viral load testing 2005 to 2018: Multi-cohort study of people living with HIV in Southern Africa

2020 ◽  
Author(s):  
Elizabeth Zaniewski ◽  
Cam Ha Dao Ostinelli ◽  
Frédérique Chammartin ◽  
Nicola Maxwell ◽  
Mary-Ann Davies ◽  
...  
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Treatment Failure ◽  
Hiv Disease ◽  
Cd4 Cell Count ◽  
Art Initiation ◽  
Advanced Hiv Disease ◽  
Cd4 Cell ◽  
Over Time ◽  
Cd4 Testing

AbstractIntroductionWHO recommends a CD4 cell count before starting antiretroviral therapy (ART) to detect advanced HIV disease, and routine viral load (VL) testing following ART initiation to detect treatment failure. Donor support for CD4 testing has declined to prioritize access to VL monitoring. We examined trends in CD4 and VL testing among adults (≥15 years of age) starting ART in Southern Africa.MethodsWe analysed data from 14 HIV treatment programs with over 300 clinics in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in years 2005-2018. We examined the frequency of CD4 and VL testing, the percentage of adults with CD4 or VL tests, and among those having a test, the percentage starting ART with advanced HIV disease (CD4 count <200 cells/mm3) or failing to suppress viral replication (>1000 HIV-RNA copies/ml) after ART initiation. We used mixed effect logistic regression to assess time trends adjusted for age and sex.ResultsAmong 502,456 adults, the percentage with CD4 testing at ART initiation decreased from a high of 78.1% in 2008 to a low of 38.0% in 2017. The percentage starting with advanced HIV disease declined from 83.3% in 2005 to 23.5% in 2018. VL testing after starting ART varied; 61.0% of adults in South Africa and 10.7% in Malawi were tested but fewer than 2% were tested in the other four countries. The probability of having a CD4 cell count at ART start declined by 14% each year (odds ratio [OR] 0.86; 95% CI 0.86-0.86); the probability of advanced HIV disease declined by 20% per year (OR 0.80; 95% CI 0.80-0.81). The increase in VL testing after ART start was only modest (OR 1.06; 95% CI 1.05-1.06) and there was no evidence of a decrease in unsuppressed VL over time (OR 1.00; 95% CI 0.99-1.01).ConclusionsCD4 cell counting declined over time, including testing at the start of ART, despite the fact that many patients still initiated ART with advanced HIV disease. Without CD4 testing and expanded VL testing many patients with advanced HIV disease and treatment failure may go undetected, threatening the effectiveness of ART in sub-Saharan Africa.

scholarly journals Identifying missed opportunities for early intervention among HIV-infected paediatric admissions at Chris Hani Baragwanath hospital, Soweto, South Africa

2011 ◽  
Vol 12 (4) ◽  
pp. 16 ◽  
Author(s):  
Angela Dramowski ◽  
Ashraf Coovadia ◽  
Tammy Meyers ◽  
Ameena Goga
Keyword(s):  
South Africa ◽  
Early Intervention ◽  
Case Fatality ◽  
Hiv Disease ◽  
Eligibility Criteria ◽  
Missed Opportunities ◽  
Childhood Morbidity ◽  
Group 12 ◽  
Polymerase Chain ◽  
Advanced Hiv Disease

Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital’s general paediatric wards between 1 October and 31 December 2007. Results. Of 1 510 admissions, 446 (29.5%) were HIV-infected. Many children (238, 54.1%) were newly diagnosed in hospital and most had advanced HIV disease (405, 92%). The principal admission diagnoses were pneumonia (165, 37.5%), gastro-enteritis (97, 22%), sepsis (86, 19.5%) and tuberculosis (92, 21%). Of children identified as HIV infected before admission, 128/202 (63.4%) were not accessing antiretroviral treatment (ART), although 121/128 (94.5%) met ART eligibility criteria. Of 364 ART-naïve eligible children, only 15 (4.1%) were commenced on ART as inpatients. Problems with PMTCT implementation in infants under 6 months (N=166) included lack of maternal antenatal HIV testing (51, 30.7%); poor uptake of maternal/infant nevirapine prophylaxis (60, 36.2%); limited use of co-trimoxazole (CTX) prophylaxis (44/147, 29.9%); and delayed infant HIV polymerase chain reaction testing (98/147, 87.5%). Of infants known to be HIV infected prior to hospitalisation, 37/51 (73%) had not initiated ART. The in-hospital case fatality rate (CFR) among HIV-infected children was triple that of the combined HIV-uninfected, exposed and unknown group (12% v. 3.6%). Infants

Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

Mycoses ◽  
2020 ◽  
Vol 63 (5) ◽  
pp. 478-487
Author(s):  
Erika van Schalkwyk ◽  
Mabatho Mhlanga ◽  
Tsidiso G. Maphanga ◽  
Ruth S. Mpembe ◽  
Amanda Shillubane ◽  
...  
Keyword(s):  
South Africa ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Hiv Disease ◽  
Academic Hospital ◽  
Advanced Hiv Disease

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

2013 ◽  
Vol 125 (13-14) ◽  
pp. 402-407 ◽  
Author(s):  
Katharina Grabmeier-Pfistershammer ◽  
Armin Rieger ◽  
Thomas Schröck ◽  
Michael Schlag
Keyword(s):  
Economic Burden ◽  
Late Presentation ◽  
Hiv Disease ◽  
Advanced Hiv Disease

scholarly journals Advanced HIV Disease Management Practices within Inpatient Medicine Units at a Referral Hospital in Zambia: A Retrospective Chart Review

2021 ◽  
Author(s):  
Nyuma Mbewe ◽  
Michael J. Vinikoor ◽  
Sombo Fwoloshi ◽  
Mundia Mwitumwa ◽  
Shabir Lakhi ◽  
...  
Keyword(s):  
Management Practices ◽  
Retrospective Chart Review ◽  
University Teaching ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Hiv Viral Load ◽  
Inpatient Medicine ◽  
Inpatient Settings ◽  
Advanced Hiv Disease ◽  
Hiv Programs

Abstract Background Zambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis. Methods We reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 20218 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment – including tuberculosis (TB), Cryptococcus, and OI prophylaxis with cotrimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines. Results We reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed. Conclusions Inconsistent CD4 testing reduced recognition of advanced HIV and OI screening was suboptimal, in part due to laboratory challenges. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including VL testing.

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