Late HIV presentation – missed opportunities and factors associated with a changing pattern over time

Delayed diagnosis of HIV infection has negative clinical, economic and public health implications. The study primary aim was to identify factors associated with late HIV presentation (Late Presenters [LPS], CD4 cell count < 350 cells/mm3). A secondary aim was to identify changing trends of late HIV presentation from 2002 to 2014 at our centre. A retrospective cohort study was performed. Demographic data and CD4 cell count of new HIV diagnoses presenting to our ambulatory HIV service over four time-periods from 2002 to 2014 were recorded. Proportion of LPS and factors associated with late presentation were compared using Graphpad Instat. In 2014, of 231 new patients attending for HIV care, 75 (32.6%) were late presenters versus 146 (66.4%) in 2002. This indicates a decreasing proportion of LPS from 2002 to 2014. However, the proportion of those with CD4 cell counts <200 on presentation at these two time intervals remain unchanged. The overall proportion of male LPS has increased over time and the proportion of LPS in the men who have sex with men (MSM) cohort has decreased over time, reflecting increased frequency of both HIV testing and diagnoses in MSM in recent years. The proportion of heterosexual LPS has not changed significantly in the same time period and LPS were older in 2014 versus 2002. The proportion of LPS defined by CD4 cell count remains higher than is justifiable in an era of increased HIV testing and awareness. Further targets for HIV testing to decrease rates of LPS include non-traditional risk groups including heterosexual and older patient cohorts. LPS rates are lower than rates found internationally, and it is possible that consensus definition of LPS needs to be revised.

Download Full-text

Does community-based point of care HIV testing reduce late HIV diagnosis? A retrospective study in England and Wales

International Journal of STD & AIDS ◽

10.1177/0956462416688573 ◽

2017 ◽

Vol 28 (11) ◽

pp. 1098-1105 ◽

Cited By ~ 5

Author(s):

Nell Freeman-Romilly ◽

Paula Sheppard ◽

Sarika Desai ◽

Nick Cooper ◽

Michael Brady

Keyword(s):

Hiv Testing ◽

Cell Count ◽

Point Of Care ◽

Community Settings ◽

Hiv Diagnosis ◽

Cd4 Cell Count ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Hiv Test ◽

Cd4 Cell

The objective of this study was to investigate if patients diagnosed in community clinics have higher baseline CD4 cell counts than those diagnosed in Genitourinary medicine (GUM)/HIV clinics. We undertook a retrospective review of baseline CD4 cell counts for patients receiving a reactive HIV test in community-testing clinics. Eleven local HIV clinics were contacted to determine the baseline CD4 cell counts of these patients. Baseline CD4 cell counts of those diagnosed in the community were compared with mean local GUM/HIV clinic and median national baseline CD4 cell count for their year of diagnosis. Clients diagnosed in community settings had a mean baseline CD4 cell count of 481 cells/mm3 (SD 236 cells/mm3) and median baseline of 483 cells/mm3 (interquartile range 311–657 cells/mm3). This was significantly higher than those diagnosed in the GUM/HIV clinic local to the community-testing site (mean baseline CD4 397 cells/mm3, p = 0.014) and the national median for that year (336 cells/mm3, p < 0.001). HIV testing in community settings identifies patients at an earlier stage of infection than testing in clinical settings.

Download Full-text

Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients

Journal of the International AIDS Society ◽

10.7448/ias.17.1.18804 ◽

2014 ◽

Vol 17 (1) ◽

pp. 18804 ◽

Cited By ~ 38

Author(s):

Sasisopin Kiertiburanakul ◽

David Boettiger ◽

Man Po Lee ◽

Sharifah Fs Omar ◽

Junko Tanuma ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Cell Count ◽

Hiv Positive ◽

Cd4 Cell Count ◽

Factors Associated ◽

Late Initiation ◽

Cd4 Cell ◽

Over Time

Download Full-text

The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance (Preprint)

10.2196/preprints.11136 ◽

2018 ◽

Author(s):

Brian Rice ◽

Andrew Boulle ◽

Sandra Schwarcz ◽

Amir Shroufi ◽

George Rutherford ◽

...

Keyword(s):

Cell Count ◽

Hiv Care ◽

Clinical Decisions ◽

Hiv Viral Load ◽

Cd4 Cell Count ◽

Aids Epidemic ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Load Monitoring ◽

Cd4 Cell

UNSTRUCTURED The move toward universal provision of antiretroviral therapy and the expansion of HIV viral load monitoring call into question the ongoing value of CD4 cell count testing and monitoring. We highlight the role CD4 monitoring continues to have in guiding clinical decisions and measuring and evaluating the epidemiology of HIV. To end the HIV/AIDS epidemic, we require strategic information, which includes CD4 cell counts, to make informed clinical decisions and effectively monitor key surveillance indicators.

Download Full-text

Presentation to HIV care and antiretroviral therapy initiation and response in clinical practice from 2003 through 2013

International Journal of STD & AIDS ◽

10.1177/0956462419841219 ◽

2019 ◽

Vol 30 (9) ◽

pp. 853-860

Author(s):

Andrea M Pallotta ◽

Sana A Pirzada ◽

Rabin K Shrestha ◽

Belinda Yen-Lieberman ◽

Leonard H Calabrese ◽

...

Keyword(s):

Clinical Practice ◽

Cell Count ◽

Treatment Guidelines ◽

Hiv Care ◽

Hiv Positive ◽

Cd4 Cell Count ◽

One Year ◽

Cd4 Cell ◽

Over Time

Universal HIV screening and treatment initiation of HIV-positive persons are well-established standards. However, late presentation to care is a barrier to early antiretroviral therapy (ART) and prevention of HIV transmission. We sought to determine the immunodeficiency at presentation to care and characterize the initiation and response to ART among HIV-positive persons over 2003–2013 in our urban HIV clinical practice at the Cleveland Clinic. Using a retrospective cohort study design, we assessed the CD4 cell count of HIV-positive patients at entry into care for each year and evaluated the trend over time. For patients who initiated treatment, we assessed the pretreatment CD4 cell count, consistency of timing and regimen with US treatment guidelines, and HIV RNA level at one-year and last follow-up visits. Regression analyses were used to determine predictors of study outcomes. We found that the cohort (N = 452) median CD4 cell count at presentation to care was 297 cells/mm3 (inter-quartile range: 104–479 cells/mm3), without any significant change over time (P = 0.62), and with 37% and 21% of presentations being late and advanced, respectively. Guideline-consistency (85%–100%) and regimen-consistency (41%–100%) were moderate to high and improved over time. Virologic suppression (<400 copies/ml) at one year and last follow-up was high (79% and 92%) and associated with regimen selection and durability. We conclude that CD4 cell count at first presentation to HIV care remained less than 350 cells/mm3 for 11 years in our clinical practice, despite advances in HIV testing and treatment guidelines. Early diagnosis and linkage to care and treatment are critical for ending the HIV epidemic.

Download Full-text

Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽

10.1159/000514385 ◽

2021 ◽

pp. 1-5

Author(s):

Mohammad Reza Jabbari ◽

Hoorieh Soleimanjahi ◽

Somayeh Shatizadeh Malekshahi ◽

Mohammad Gholami ◽

Leila Sadeghi ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Cell Count ◽

Previous History ◽

Cd4 Count ◽

Cd4 Cell Count ◽

Cell Counts ◽

Immunodeficiency Virus ◽

Cd4 Cell ◽

Hiv 1

Objectives: The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count <100 cells/mm3 and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. Methods: This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count <100 cells/mm3, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). Results: Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (p value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (p < 0.02). Conclusions: We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count <100 mm3/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

Download Full-text

A Systematic Review and Meta-regression of Temporal Trends in Adult CD4+ Cell Count at Presentation to HIV Care, 1992-2011

Clinical Infectious Diseases ◽

10.1093/cid/cit421 ◽

2013 ◽

Vol 57 (7) ◽

pp. 1027-1037 ◽

Cited By ~ 60

Author(s):

C. R. Lesko ◽

S. R. Cole ◽

A. Zinski ◽

C. Poole ◽

M. J. Mugavero

Keyword(s):

Systematic Review ◽

Cell Count ◽

Temporal Trends ◽

Hiv Care ◽

Cd4 Cell Count ◽

Meta Regression ◽

Cd4 Cell

Download Full-text

Factors associated with late presentation of HIV infection in Catalonia, Spain

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.011280 ◽

2012 ◽

Vol 23 (7) ◽

pp. 475-480 ◽

Cited By ~ 19

Author(s):

N Vives ◽

D Carnicer-Pont ◽

P Garcia De Olalla ◽

N Camps ◽

A Esteve ◽

...

Keyword(s):

Hiv Infection ◽

Late Presentation ◽

Late Diagnosis ◽

Cd4 Cell Count ◽

Hiv Surveillance ◽

Factors Associated ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Populations At Risk ◽

Cd4 Cell

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend ( P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

Download Full-text

The correlation of tuberculosis smear results and immuno-suppression with CD4+ counts as a surrogate marker among HIV infected patients.

10.21203/rs.3.rs-1060928/v1 ◽

2021 ◽

Author(s):

Kingsley Kamvuma ◽

Yusuf ademola ◽

Warren Chanda ◽

Christopher Newton Phiri ◽

Sam Bezza Phiri ◽

...

Keyword(s):

Cell Count ◽

Surrogate Marker ◽

Hiv Positive ◽

Sputum Smear ◽

Cd4 Cell Count ◽

Cd4 Counts ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Study Participants ◽

Cd4 Cell

Abstract Background: Human immunodeficiency virus (HIV) and M.tuberculosis are two intracellular pathogens that interact at the cellular, clinical and population levels. Since the recognition of AIDS in 1981, the number of reported cases of TB in the has increased substantially, especially in regions with high incidence of AIDS. The main aim of this study was to establish weather there is a relationship between sputum smear positives and low CD4 cell counts among HIV infected patients.Materials and methods: This was a retrospective study involving 473 participants. The patients recruited in this study were those who tested HIV positive and smear positive for TB. Their HIV status was determined by performing an HIV blood test, if they were HIV positive their CD4 cell count were then made.Results: This study examined the relation between smear positivity and low CD4 (below 200cells/µl) together with CD8 and CD3 markers as a measure of immune function among patients infected with HIV. The study participants’ constituted males 67% and females 33%. The overall mean age was 33.2 (SD 6.9) with the youngest and oldest participants being 18 and 60 respectively. It was found that smear positive results negatively (r=-0.13; p=0.021) correlated with CD4+ below 200 cells/µl. No correlation was observed between smear positives and CD8+ or CD3+ since the calculated correlation coefficient was not significant 0.007 (p=0.9) and 0.03 (p=0.6) respectively. There are more 3+ smear results below 200 cells/µl than the others while above 200 cells/µl 1+ was the most commonly reported smear result. The scanty smear positives were the least commonly reported result in the low and high CD4 counts. Conclusion: The smear positive result negatively correlated with a low CD4+ (r=-0.13; p=0.021) but no correlation with low CD+8 and CD+3 results was observed. The long held theory that low bacillary counts in patients with low CD4+ counts needs to be revisited. The reduction of CD4+ cell count parallels' that of the total lymphocyte count and is more marked in patients with high bacillary counts. Further, studies are required to confirm these findings

Download Full-text