Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012–2017

2020 ◽  
Vol 31 (8) ◽  
pp. 791-799
Author(s):  
Maria A Robles ◽  
Alma Y Ortiz ◽  
Yamitzel Zaldivar ◽  
Jorge Castillo ◽  
Jessica Gondola ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Age Groups ◽  
Late Presentation ◽  
Study Data ◽  
Clinical Factors ◽  
Cd4 Cell Count ◽  
Cd4 Lymphocyte ◽  
The Republic ◽  
Routine Hiv Testing ◽  
Cd4 Cell

Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1–1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8–2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6–2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.

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

2012 ◽  
Vol 23 (7) ◽  
pp. 475-480 ◽  
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.

CD4/CD8 ratio improvement in HIV-1-infected patients receiving dual antiretroviral treatment

2019 ◽  
Vol 30 (7) ◽  
pp. 656-662 ◽  
Author(s):  
Marta Monsalvo ◽  
Alejandro Vallejo ◽  
María Fontecha ◽  
María J Vivancos ◽  
Pilar Vizcarra ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Ratio Increase ◽  
Related Factors ◽  
Cd4 Cell Count ◽  
Lower Baseline ◽  
Baseline Values ◽  
A Prospective Study ◽  
Aids Diagnosis ◽  
Cd4 Cell ◽  
Hiv 1

The CD4/CD8 ratio is an indirect marker of immune activation, immune senescence, and inflammation in HIV infection. We performed a prospective study of the CD4/CD8 ratio evolution in 245 virally-suppressed (median, 55 months) HIV-infected patients (29% females) who had switched to four dual antiretroviral regimens. At baseline, the median CD4/CD8 ratio was 0.71 (interquartile range, IQR, 0.46–0.97), associated with duration of HIV infection, nadir CD4+ cell count, and AIDS diagnosis. It was lower in the case of hepatitis C virus coinfection and cardiovascular disease (p = 0.09), but the ratio was higher in patients with chronic kidney disease, proteinuria, or osteoporosis. At 48 weeks, the median CD4/CD8 ratio increased by 3% (+0.02; IQR, –0.07, +0.09; p = 0.07); greater improvement was observed in patients with lower baseline ratios and previous AIDS diagnosis. The slope of increase was slower in patients with the highest baseline values. Also, there were no differences in the CD4/CD8 ratio increase according to type of dual regimen, after adjusting for baseline and HIV-related values. In conclusion, CD4/CD8 ratio increase is observed during suppressive dual regimens, and its extent is related to baseline values and previous HIV-related factors. Longer duration on antiretroviral therapy and drug toxicity could affect the evolution of this marker in the presence of comorbidities.

scholarly journals Using record linkage to assess the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa.

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Chodziwadziwa Whiteson Kabudula ◽  
Georges Reniers ◽  
Francesc Xavier Gómez-Olivé ◽  
Kathleen Kahn ◽  
Stephen Tollman
Keyword(s):  
South Africa ◽  
Cell Count ◽  
Late Presentation ◽  
Short Term ◽  
Cd4 Cell Count ◽  
Short Term Mortality ◽  
Care And Treatment ◽  
Cd4 Cell ◽  
The Impact ◽  
Rural South Africa

ABSTRACT ObjectivesTo assess the impact of late presentation (CD4 cell count <200 cells/μl at presentation) for care and treatment on short-term mortality (death within a year of presentation) among HIV-infected adults in rural South Africa. ApproachWe applied deterministic and probabilistic record linkage approaches to link adult patients seeking care and treatment for HIV from a health facility between 2007 and 2013 to population under continuous surveillance by the Agincourt Health and Demographic Surveillance System (HDSS) in rural northeast South Africa. The resulting record-linked dataset was thereafter analysed to estimate short-term mortality (death within a year of presentation) differences in late presenters (initial presentation at health facility with CD4 cell count less than 200 cells/μl) and early presenters (presentation with CD4 cell count of 200 or more cells/μl). In the linked dataset, CD4 cell count was extracted from the health facility database where as date of death came from the HDSS database. ResultsA total of 3,553 patients who sought care and treatment for HIV at Bhubhezi clinic between 2007 and 2013 were linked to the Agincourt HDSS surveillance population. Proportion of patients classified as late presenters was 60.9%. Short-term mortality was 8.9% (317/3,553): 11.1% among those who presented late and 5.5 % among those who presented early (P<0.001). ConclusionRecord linkage facilitated the assessment of the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa. In the population studied, late presentation is high and is contributing to high mortality among people living with HIV. Strategies that would facilitate early presentation are needed in order to reduce mortality among people living with HIV.

Amount of lymphatic tissue fibrosis in HIV infection predicts magnitude of HAART-associated change in peripheral CD4 cell count

AIDS ◽  
2005 ◽  
Vol 19 (18) ◽  
pp. 2169-2171 ◽  
Author(s):  
Timothy W Schacker ◽  
Cavan Reilly ◽  
Gregory J Beilman ◽  
Jodie Taylor ◽  
David Skarda ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Lymphatic Tissue ◽  
Tissue Fibrosis ◽  
Cd4 Cell Count ◽  
Cd4 Cell

scholarly journals IS IT SAFE AND COST SAVING TO DEFER THE CD4+ CELL COUNT MONITORING IN STABLE PATIENTS ON ART WITH MORE THAN 350 OR 500 CELLS/µL?

2019 ◽  
Vol 11 (1) ◽  
pp. e2019063
Author(s):  
Benedetto Maurizio Celesia ◽  
Andrea Marino ◽  
Rosa Fontana del Vecchio ◽  
Roberto Bruno ◽  
Filippo Palermo ◽  
...  
Keyword(s):  
Cell Count ◽  
Mean Value ◽  
Cd4 Count ◽  
Cd4 Cells ◽  
Cd4 Cell Count ◽  
The Third ◽  
Cd4 Lymphocyte ◽  
Mean Cost ◽  
Cd4 Cell

Background CD4 lymphocyte cell count represents the main immunological marker used to monitor HIV infection. However, frequent monitoring may be unnecessary, could cause anxiety to the patient as well as burdening healthcare with extra expenses.   Objectives and methods To analyse the probability of maintaining a safe number of CD4 in HIV-positive subjects under treatment with ≥350 cells/µl at baseline during a three-year follow up. We conducted a retrospective study performing three analyses with Kaplan-Meyer method considering: 1) all patients independently from their viral load (VL); 2) patients with 500 > CD4 ≥ 350 cells/µl versus (vs) CD4 ≥ 500 cells/µl at baseline; 3) patients with VL < 20 copies/ml vs VL > 20 copies/ml.   Results 253 subjects were enrolled. The median CD4 count was 623 (489-805) cells/µl. Subjects maintaining ≥ 350 cells/µl in the first, second and third year were respectively 238 (94.1%), 229 (90.5%) and 226 (89.3%), independently from VL. Within subjects with ≥ 350 CD4/µl vs ≥ 500 CD4/µl at baseline, those who maintained ≥ 350 cells/µl until the third year were respectively 241 (95.3%) and 158 (98.1%). The probability of maintaining these values in the third year was 89.3% for those who had CD4 ≥ 350/µl at baseline and 98.1% for those who had CD4 ≥ 500/µl. This probability was around 90% vs 99% for subjects with HIV-RNA above or below 20 copies/ml. Secondly, we tried to estimate the costs of CD4 determinations in a three-year period (from April 1, 2013 to March 31, 2016). We analysed respectively 343 subjects in the first period, 364 in the second and 383 in the third, with a median value of 500 CD4/µl during the research time taken into account. We found a mean value of about two determinations patient/year (2.41 in 2013/2014; 2.32 in 2014/2015; 2.18 in 2015/2016), with a significant decrease between the first and the last period (p<0.001). The mean cost patient/year was €101.51 in the first year, €97.61 in the second, €92.00 in the third (p<0,001). Assuming to extend these procedures to all our patients with stable CD4 cells/µl and monitoring CD4 cell count once in a year, it could be possible to obtain an overall saving of €19,152/year.   Conclusions A very high percentage of subjects maintained a high and safe number of CD4 cells (>350 cells/µl) during a three-year follow up. It could be possible to save up to 66% of the costs by reducing the number of CD4 count determinations in a year, to have other favourable consequences as well, releasing new resources for patient’s management.

Sustained Cognitive Decline in HIV Infection: Relationship to CD4+ Cell Count, Plasma Viremia and p24 Antigenemia

1998 ◽  
Vol 4 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Gerald J Dal Pan ◽  
Homayoon Farzadegan ◽  
Ola Seines ◽  
Donald R Hoover ◽  
Eric N Miller ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cognitive Decline ◽  
Cell Count ◽  
Plasma Viremia ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Hodgkin’s disease and HIV infection (HD-HIV): Prognostic factors in 596 patients (pts) within the group of European Cooperation on AIDS and Tumors (GECAT).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8058-8058
Author(s):  
Michele Spina ◽  
Josep-Maria Ribera ◽  
Jean Gabarre ◽  
Christoph Wyen ◽  
Silvia Montoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cd4 Cell Count ◽  
Highly Active ◽  
Cd4 Cell

8058 Background: Hodgkin’s disease (HD) is the most common non-AIDS defining tumour diagnosed in HIV setting. The introduction of highly active antiretroviral therapy (HAART) has opened a new prospective in the treatment of pts with HD-HIV as the better control of the underlying HIV infection allows the use of more aggressive chemotherapy regimens, including high dose chemotherapy. However, up to now prognostic factors on overall survival (OS) or time to treatment failure (TTF) have not yet been identified. Methods: In order to identify prognostic factors, we analyzed data on 596 pts with HD-HIV diagnosed and treated in 90 different Institution of 6 European countries from October 1983 to March 2010. All factors were analyzed for OS and TTF. Results: 86% of pts were male and the median CD4 cell count was 224/dl (range 3-1274); 52% of pts had mixed cellularity subtype, stages III-IV were diagnosed in 72% of cases and 55% of pts had extranodal involvement (bone marrow 35%, spleen 21%, liver 14%). The table summarizes the results of multivariate analysis. Conclusions: We identified a new “European Score” for HD-HIV able to predict different outcomes in these patients. This score should be considered for future prospective studies. [Table: see text]

scholarly journals HIV Infection, Antiretroviral Therapy, and CD4+Cell Count Distributions in African Populations

2006 ◽  
Vol 194 (10) ◽  
pp. 1450-1458 ◽  
Author(s):  
Brian G. Williams ◽  
Eline L. Korenromp ◽  
Eleanor Gouws ◽  
George P. Schmid ◽  
Bertran Auvert ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Cell Count ◽  
Cd4 Cell Count ◽  
African Populations ◽  
Cd4 Cell

scholarly journals Reduced P53 Protein Level and Evidence of Ongoing Coagulation among HIV-Infected Persons Accessing Treatment at University of Calabar Teaching Hospital, Nigeria

2019 ◽  
pp. 1-6
Author(s):  
E. C. Akwiwu ◽  
A. O. Okafor ◽  
J. O. Akpotuzor ◽  
E. E. Onukak
Keyword(s):  
Hiv Infection ◽  
Teaching Hospital ◽  
P53 Protein ◽  
Distribution Width ◽  
Cd4 Cell Count ◽  
Persons Living With Hiv ◽  
The University ◽  
Living With Hiv ◽  
Cd4 Cell ◽  
D Dimer

Aims: To assess tumour suppressing activity and ongoing coagulation among persons living with HIV infection and accessing care in the University of Calabar Teaching Hospital, Nigeria. Study Design: Case-control study. Place and Duration of Study: University of Calabar Teaching Hospital Calabar, Nigeria, between April 2018 and November 2018. Methods: Ninety persons living with HIV infection who were attending clinics at the University of Calabar Teaching Hospital were enrolled with ninety age and sex-matched HIV seronegative individuals who served as control subjects. The blood specimen was collected from each participant for analyses of CD4 cell and full blood counts by automation, serum was used for the assays of P53 protein and D-dimer levels using enzyme-linked immunosorbent assay test kits. Data analysis was done using SPSS version 22.0. Student t-test was used to compare means between test and control subjects. One-way analysis of variance was used to compare means across the HAART-naïve and two other groups on different HAART protocols. Statistical significance was drawn at a p≤ 0.05. Results: The CD4 cell count and P53 protein level reduced while D-dimer level increased in HIV infection. Platelet count also reduced while platelet distribution width increased with the condition. While CD4 cell count improved with Highly Active Antiretroviral Therapy administration, D-dimer level, mean platelet volume and platelet distribution width reduced. Conclusion: This study observed reduced tumour suppression and increased coagulation activities alongside immunosuppression in HIV infection.

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