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 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&lt; count &lt;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 &lt;100 cells/µl. Results Amongst 259 088 CD4 outcomes extracted, 5.4% of samples had counts &lt;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 &lt;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 113. Advanced HIV Disease Among Adults in the African Cohort Study (AFRICOS)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S185-S185
Author(s):  
Ikwo Oboho ◽  
Allahna L Esber ◽  
Nicole Dear ◽  
Heather Paulin ◽  
Michael Iroezindu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Stage ◽  
Scale Up ◽  
World Health ◽  
Hiv Disease ◽  
Hiv Diagnosis ◽  
Factors Associated ◽  
Test And Treat ◽  
Study Enrollment ◽  
Advanced Hiv Disease

Abstract Background In the “test and treat” era, early ART may decrease the prevalence of advanced HIV disease (AHD), defined as having a CD4 cell count &lt; 200 cells/µL or World Health Organization (WHO) clinical stage III or IV disease. We assessed trends in AHD and ART coverage and describe factors associated with AHD among adults living with HIV (LWH) across four countries before and during the “test and treat” era. Methods The African Cohort Study (AFRICOS) is a prospective cohort enrolling adults at risk for HIV or LWH from 12 facilities in Uganda, Kenya, Tanzania and Nigeria. Clinical history review and laboratory testing were performed at enrollment and every 6 months. Serum cryptococcal antigen screening (CrAg) was performed in a subset with CD4 &lt; 200 at enrollment. Logistic regression was used to estimate odds ratios for factors associated with CD4 &lt; 200. Results From January 2013–December 2019, 2934 adults LWH were enrolled (median age 38 years [interquartile range, 31–46 years], 41.5% men). Of 2903 with CD4 results at enrollment, 567 (19.5%) had CD4 &lt; 200. Despite consistent increases in ART coverage since 2016, across all countries the prevalence of AHD did not decline below levels observed in 2013 until 2019. The prevalence of CD4 &lt; 200 did not significantly decline from 11.9% (range 9.1–25.0%) in 2013 to 10.3% (range 0–16%) in 2019, p=0.7, while ART coverage increased from 74.7% (range 68.3–93.8%) in 2013 to 97.5% (range 86–100%) in 2019, p= &lt; 0.01 (Figure 1). Factors associated with a higher risk of CD4 &lt; 200 at enrollment were being enrolled in Tanzania, male sex, age &gt;29 years, having a primary or some secondary education or above, and WHO stage II disease or higher. Factors associated with a lower risk of CD4 &lt; 200 were &gt;1 year since HIV diagnosis and being on ART for at least 6 months (Table 1). Among those with CD4 &lt; 200 at enrollment, the most commonly reported comorbidities included HIV wasting syndrome (9.3%) and tuberculosis (TB) (2.3%); 19 (3.4%) of 564 adults screened were CrAg positive. Figure 1: Trends in Percentage of Participants with CD4 &lt;200 and ART coverage at Study Enrollment by Country and Year Table 1: Factors associated with CD4 &lt;200 cells/mm3 at Study Enrollment Conclusion Despite the scale-up of ART in the era of “test and treat”, AHD prevalence has only recently trended downward. Continued efforts towards early HIV diagnosis and timely ART initiation are needed to reduce the risk for CD4&lt; 200. Strategies to increase TB screening, prophylaxis, and treatment are essential to reduce morbidity. Disclosures All Authors: No reported disclosures

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

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
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.

Prevalence and Determinants of Fertility Desire Among HIV-positive Women in Rwanda in the Context of Improved Life Expectancy: A Statistical Analysis of Cross-Sectional Data

2020 ◽  
Author(s):  
François Niragire ◽  
Celestin Ndikumana ◽  
Marie Gaudence Nyirahabimana ◽  
Dieudonne Uwizeye
Keyword(s):  
Logistic Regression ◽  
Scale Up ◽  
Reproductive Age ◽  
Hiv Positive ◽  
Multivariable Logistic Regression Analysis ◽  
People Living With Hiv ◽  
Fertility Desire ◽  
Cross Sectional ◽  
Multivariable Logistic Regression ◽  
Hiv Positive Women

Abstract Background: The knowledge of the key determinants of fertility desire among people living with HIV/AIDS is crucial for the design of efficient maternal and child health care programs. However, such determinants are not well understood in the context of a successful scale-up of antiretroviral therapy in Rwanda. The present study aim was to assess fertility desire among HIV- positive women and its determinants in Rwanda.Methods: Data were extracted from the 2015 Rwanda demographic health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable based variable selection as well as multivariable logistic regression analysis were conducted. Results: The prevalence of desire to have another child in HIV-positive women was as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age, number of her living children, woman’s employment status, and having a co-wife are significant determinants of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, who were unemployed or who had at least a co-wife were associated with greater odds of desire to have another child in the future than other HIV- positive women.. Conclusion: There is a need to devise integrated programs and services that are tailored to support HIV-positive women in planning their fertility, and controlling HIV transmission to their prospective children. Efficient policy and fertility interventions among WLHA in Rwanda should target young women, especially those living with partners and have fewer children than they prefer.

scholarly journals 326. Is Antiretroviral Treatment Averting AIDS and non-AIDS Defining Malignancies in Colombia?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S172-S173
Author(s):  
Ernesto Martínez Buitrago ◽  
Leonardo Arévalo Mora ◽  
Mónica Mantilla Suárez ◽  
Sandra Valderrama ◽  
Claudia Gonzáles ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Antiretroviral Treatment ◽  
Treatment Success ◽  
Kaposi Sarcoma ◽  
Retrospective Chart Review ◽  
Late Presentation ◽  
Bivariate Analysis ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count

Abstract Background The use of effective antiretroviral therapy (ART) has shown to modify the trend of AIDS-defining malignancies (ADM) toward non-AIDS defining malignancies (NADM); however, Latin America is a region with a known late presentation of HIV/AIDS and late initiation of ART, which could not result in averting the incidence of ADM. The epidemiology of cancers that define or not AIDS in people living with HIV in Colombia is not known. Methods The purpose of our study was to identify the trend of ADM and NADM and the effect of ART in a collective cohort of 15 centers of 8 cities in Colombia. After the institutional review board approval, the study was conducted as a retrospective chart review of patients with any diagnosis of cancer presented after the diagnosis of HIV and a year before. Demographic and clinical data related to the HIV infection, ART treatment, and cancer diagnosis were analyzed with Stata 12 software, and associations between different variables were made using univariate and bivariate analyses. Results A total of 415 patients with malignancies were included since 1986 (table). Most common cancers were Kaposi sarcoma (n = 227; 54.7%), and non-Hodgkin lymphoma (n = 80, 19,3%). Median CD4+ cell count was very low in this population (median 115.5, P25-75 39.5–243) at the time of HIV diagnosis. Most common NADM were skin cancer (n = 22; 5.3%) and Hodgkin lymphoma (15; 3.6%). The ratio of ADM:NADM was 0.5 before 1995 and increased progressively up to 3.0 after 2010 (P = 0.001) (figure). By bivariate analysis, we found a correlation of ADM with older age (P < 0.001), male gender (P = 0.03), recent years (P < 0.001), lower CD4 and higher VL at the time of cancer (P < 0.0001 for both), and mortality (P = 0.027). Cancer-associated mortality was 3.9%. Conclusion The trend for diagnosis of ADM in Colombia is increasing despite antiretroviral treatment and exceeds NADM diagnosis. Potential explaining factors are the late presentation and initiation of ART, and poor treatment success in this population. Special efforts are required to diagnose and treat HIV patients in Colombia to avert this worrying trend. Disclosures All authors: No reported disclosures.

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.

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 Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004–2018

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249864
Author(s):  
Marta Rava ◽  
Lourdes Domínguez-Domínguez ◽  
Otilia Bisbal ◽  
Luis Fernando López-Cortés ◽  
Carmen Busca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Negative Impact ◽  
Composite Endpoint ◽  
Late Presentation ◽  
Research Network ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Increased Risk

Objectives With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004–2018. Methods CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). Results 14,876 individuals were included. Overall, LP prevalence in 2004–2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). Conclusions LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.

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