scholarly journals Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Amilcar Azamar-Alonso ◽  
Sergio A. Bautista-Arredondo ◽  
Fiona Smaill ◽  
Lawrence Mbuagbaw ◽  
Andrew P. Costa ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Major Change ◽  
Population Based ◽  
Health Facilities ◽  
Late Diagnosis ◽  
Cd4 Count ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Late Hiv Diagnosis ◽  
The Impact

Abstract Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013–2017 National HIV program. Methods Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013–2017 (i.e. before and after the implementation of the 2013–2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. Conclusions The results of this study indicate that the 2013–2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.

scholarly journals Patient Characteristics and Determinants of CD4 at Diagnosis of HIV in Mexico from 2008 to 2017: A 10-Year Population-Based Study

2020 ◽  
Author(s):  
Amilcar Azamar Alonso ◽  
Sergio A Bautista-Arredondo ◽  
Fiona Smaill ◽  
Lawrence Mbuagbaw ◽  
Andrew P Costa ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Major Change ◽  
Population Based ◽  
Health Facilities ◽  
Late Diagnosis ◽  
Cd4 Count ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Late Hiv Diagnosis ◽  
The Impact

Abstract Background: Worldwide, around 37.9 million people are living with HIV, of which 220,000 live in Mexico. In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. Methods: Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results: the study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45% to 43% (P <0.001) between 2008-2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013-2017 (odds ratio [OR]= 0.96 [95% Confidence interval [CI]: [0.93, 0.98]) or in health facilities specialized in HIV (OR=0.64 [95% CI: 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis.Conclusions: The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico.

scholarly journals 1300. Symptom Driven Testing Is not Enough: A Retrospective Review of Patients Enrolled into HIV Care 2015–2018 at a Ryan White Patient-Centered Medical Home in Pittsburgh, Pennsylvania

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S468-S469
Author(s):  
Nicholas Cheronis ◽  
Holly Bean ◽  
Marissa Tremoglie ◽  
Cindy Magrini ◽  
Lucas Blazejewski ◽  
...  
Keyword(s):  
High Risk ◽  
Early Diagnosis ◽  
Cd4 Count ◽  
Hiv Care ◽  
Health Clinic ◽  
Newly Diagnosed ◽  
Hiv Diagnosis ◽  
Hiv Viral Load ◽  
Missed Opportunities ◽  
Ryan White

Abstract Background While current CDC guidelines recommend screening between the ages of 13–64 at least once and annually for high-risk individuals, this is often not practiced. Early diagnosis has become key to preventing the spread of HIV. It has been suggested that a late diagnosis, one where a patient is symptomatic, implies a loss of 10.5 years in their lifespan. Methods From January 1, 1, 2015 to December 31, 2018, 113 newly diagnosed HIV-infected patients enrolled in care at The Positive Health Clinic (PHC), a Ryan White funded clinic, located in Pittsburgh, PA. Results The median age was 32, 78% male, 64% MSM (Figure 1). At the time of HIV diagnosis, the median CD4 count was 325 U/L and HIV viral load was 65,000 copies. 32 patients (28%) had a CD4 count <200 and 13 had an AIDS-defining illnesses (Figure 2). Only 50% of HIV diagnoses were based on a provider’s clinical suspicions, 26% were driven by patient request, and 24% were the result of system driven screenings. 90.2% of patients had prior healthcare contact before the HIV diagnoses, suggesting missed opportunities. Of all the newly diagnosed HIV patients, 62% were symptomatic, prompting them to be tested for HIV (Figure 3). In 20% of the symptomatic cases, the patient requested to be tested for HIV, highlighting missed opportunities for clinicians to include HIV in their differential. A previous test for HIV within one year of their HIV diagnosis positively correlated with early diagnosis (CD4 >200 copies) (P = 0.007). System driven screenings for HIV also positively correlated with early diagnosis (CD4 >200 copies) (P < 0.001). Conclusion Waiting for clinical suspicion is not enough. To prevent patients from developing life-threatening AIDS-defining illnesses screening must be done at each interaction with the healthcare system for high-risk patients and annually for patients without risk factors. Disclosures All authors: No reported disclosures.

scholarly journals Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

2019 ◽  
Vol 71 (8) ◽  
pp. e308-e315
Author(s):  
McKaylee M Robertson ◽  
Sarah L Braunstein ◽  
Donald R Hoover ◽  
Sheng Li ◽  
Denis Nash
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Population Based ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

scholarly journals CD4 Cell Counts at HIV Diagnosis among HIV Outpatient Study Participants, 2000–2009

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Kate Buchacz ◽  
Carl Armon ◽  
Frank J. Palella ◽  
Rose K. Baker ◽  
Ellen Tedaldi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Population Level ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Cell Counts ◽  
Late Hiv Diagnosis ◽  
Cd4 Cell Counts ◽  
The Usa ◽  
Study Participants ◽  
Cd4 Cell

Background. It is unclear if CD4 cell counts at HIV diagnosis have improved over a 10-year period of expanded HIV testing in the USA.Methods. We studied HOPS participants diagnosed with HIV infection ≤6 months prior to entry into care during 2000–2009. We assessed the correlates of CD4 count <200 cells/mm3at HIV diagnosis (late HIV diagnosis) by logistic regression.Results. Of 1,203 eligible patients, 936 (78%) had a CD4 count within 3 months after HIV diagnosis. Median CD4 count at HIV diagnosis was 299 cells/mm3and did not significantly improve over time (P=0.13). Comparing periods 2000-2001 versus 2008-2009, respectively, 39% and 35% of patients had a late HIV diagnosis (P=0.34). Independent correlates of late HIV diagnosis were having an HIV risk other than being MSM, age ≥35 years at diagnosis, and being of nonwhite race/ethnicity.Conclusions. There is need for routine universal HIV testing to reduce the frequency of late HIV diagnosis and increase opportunity for patient- and potentially population-level benefits associated with early antiretroviral treatment.

scholarly journals The Nutritional Status of Adult Antiretroviral Therapy Recipients with a Recent HIV Diagnosis; A Cross-Sectional Study in Primary Health Facilities in Gauteng, South Africa

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 290
Author(s):  
Khabo Mahlangu ◽  
Perpetua Modjadji ◽  
Sphiwe Madiba
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Nutritional Status ◽  
Health Facilities ◽  
The Body ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Cross Sectional ◽  
Primary Health ◽  
Primary Health Facilities

The study determined the nutritional status of adult antiretroviral therapy (ART) recipients, and investigated the association between the duration on ART and the nutritional status. This study was based in primary health facilities in Gauteng, South Africa. The data collected included sociodemographic variables; the duration of the treatment; and the body mass index (BMI), classified as undernutrition (<18.5 kg/m2), normal (18.5–24.9 kg/m2), or overweight/obesity (≥25 kg/m2). ART recipients (n = 480) had a mean age of 35 (± 8.4SD) years. All had taken ART for six months or more (range 6–48 months). The data were analyzed using STATA 13.0. The overall prevalence of overweight/obesity was 39%, it was higher in females (46%) than in males (30%), 26% were overweight, and 13% were obese. Underweight was 13%, and was higher in males (18%) than females (9%). Being overweight was more likely in those aged ≥35 years and those in smaller households. Being obese was less likely in males, in the employed, and in those with a higher income, but was more likely in those with a longer duration on ART. Abdominal obesity was high, but less likely in males. Interventions to prevent overweight/obesity should be integrated into routine HIV care, while at the same time addressing the burden of undernutrition among ART recipients.

scholarly journals The impact of COVID-19 pandemic on HIV care continuum in Jiangsu, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lingen Shi ◽  
Weiming Tang ◽  
Haiyang Hu ◽  
Tao Qiu ◽  
Gifty Marley ◽  
...  
Keyword(s):  
Moving Average ◽  
Information Management System ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Newly Diagnosed ◽  
Public Health Services ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Care Continuum ◽  
The Impact

Abstract Background The COVID-19 pandemic seriously threatens general public health services globally. This study aimed to evaluate the impact of the COVID-19 pandemic on the HIV care continuum in Jiangsu province, China. Methods Data on newly diagnosed HIV persons for analysis were retrieved from Chinas’ web-based Comprehensive Response Information Management System (CRIMS) for HIV/AIDS from 2016 to 2020. We recorded data for the first 3 months (January to March, 2020) of strictly implementing COVID-19 measures from publicly available disease databases of the Jiangsu provincial Health Committee. We used seasonal autoregressive integrated moving average (SARIMA) and exponential smoothing in forecasting the parameters. Subgroup differences were accessed using Chi-square tests. Results Compared to the estimated proportions, the HIV testing rates decreased by 49.0% (919,938) in the first three months of implementing COVID-19 measures. Of an estimated 1555 new HIV diagnosis expected in the same period, only 63.0% (980) new diagnoses were recorded. According to actual data recorded during the said period, 980 positively tested persons received confirmatory tests, of which 71.4% (700) were reportedly linked to care. And only 49.5% (235) out of the expected 475 newly diagnosed HIV persons received CD4 cell count testing. Meanwhile 91.6% (208) of newly diagnosed HIV persons who received CD4 count tests reportedly initiated antiretroviral therapy (ART) compared to the 227 expected. Compared to the same period from 2016 to 2019, PLWH less than 30 years old and migrants were more likely to be affected by the COVID-19 policies. Conclusions The COVID-19 pandemic negatively impacted HIV healthcare systems in Jiangsu, China. Further measures that can counter the impact of the pandemic are needed to maintain the HIV care continuum.

scholarly journals HIV Testing Uptake and Late Diagnosis among Urban Population of Ethiopia: A Multilevel Modeling Approach

2021 ◽  
Author(s):  
Yimam G Misganie ◽  
Jemal Ayalew ◽  
Ebba Abate ◽  
Adamu Tayachew ◽  
Sileshi Leulseged ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Hiv Testing ◽  
Low Income ◽  
Urban Population ◽  
Late Diagnosis ◽  
Hiv Care ◽  
P Value ◽  
People Living With Hiv ◽  
Mixed Effect ◽  
Testing Uptake

Background: Expanding HIV testing and early diagnosis requires a better understanding of determinants to uptake and late diagnosis. We investigated factors contributing to HIV testing uptake and late diagnosis. Objective: The aim of this study was to determine level of HIV Testing Uptake and Late Diagnosis among Urban Population of Ethiopia Design: We used data from the Ethiopian Population Based HIV Impact assessment in Ethiopia (EPHIA), conducted in 2017/18. EPHIA was a nationally representative, cross-sectional and household-based study, conducted in urban Ethiopia which used a two-stage cluster sampling design with stratification into small and large urban areas. The EPHIA data were collected from 19,136 adults aged 15 to 64 years. For current study, we considered self-reports first diagnosis to estimate the testing uptake and also consider HIV LAg avidity Vs Viral Load Vs plasma Antiretroviral drug level algorithm to categorize the late diagnosis. In this analysis, a 2-level multilevel mixed-effect logistic regression model was employed using STATA v16. The effects of individual-level predictors were quantified by the estimates from the fixed-effect part of the model with a p-value less than 0.05 or 95% CI. Result: By the year 2017/18, overall 29.4% of people living with HIV (PLHIV) were never tested in urban Ethiopia. Never tested male was significantly higher (32.4%; 95%: 31.0, 33.9) than females (26.4%; 95%: 25.3, 27.5) while it ranged from 28.3% to 47.8% among 45 to 54 and 15 to 24 years, respectively. By the same study period, 25.9% (95% CI: 21.7, 30.2) of PLHIV were lately diagnosed and male was significantly higher (36.8%; 95%: 28.0, 46.6) than females (20.8%; 95%: 17.3, 24.9). Late HIV diagnosis was also heterogeneous by various age group categories. Late diagnosis varies by region which ranged from 38.1% in the Gambella to 5.8% in Benishangul Gumuz. HIV testing uptake and late diagnosis was also significantly affected by alcohol use, income and educational status. Conclusion: Ethiopia was behind the global target for HIV testing uptake. Late diagnosis of HIV constituted one-quarter of all testing HIV positive, and this was significantly higher among adult males. HIV testing offer and early diagnosis strategy need to focus on addressing geographically highly affected regions, and male and young adolescent age groups. The widowed population group, which is highly affected by HIV, and has low level of testing uptake, may require due attention by the HIV program. It is also suggested that HIV care and treatment programs provide a focus to the disadvantaged populations, especially those with limited education and low income.

scholarly journals 376. Effect of Parasitic Infections on Gut Epithelial Barrier and Immune Activation among Foreign-Born HIV-infected Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S197
Author(s):  
Melissa Reimer-McAtee ◽  
Anoma Somasunderam ◽  
Teena Huan Xu ◽  
Roberto Arduino ◽  
Jose Serpa ◽  
...  
Keyword(s):  
Immune Activation ◽  
Strongyloides Stercoralis ◽  
The United States ◽  
Microbial Translocation ◽  
Cd4 Count ◽  
Parasitic Infections ◽  
Foreign Born ◽  
Hiv Diagnosis ◽  
Fatty Acid Binding ◽  
The Impact

Abstract Background Strongyloides stercoralis often causes an asymptomatic infection despite continuous autoinfection for the lifetime of the host. Both HIV and recurrent enteric parasitic infections cause gut damage and increased microbial translocation, but little is known about the effects of co-infection. We aimed to evaluate changes in immune activation, mucosal damage, and microbial translocation in people with HIV-1 (PWH) and parasite co-infection. Methods In this pilot prospective cohort study, we enrolled foreign-born PWH on suppressive antiretroviral therapy (ART) in an ambulatory clinic in Houston, Texas. We evaluated serum Strongyloides IgG using ELISA with an S. stercoralis-specific recombinant protein. Intestinal fatty acid-binding protein (I-FABP), soluble CD14 (sCD14), sCD163, IL-6, and sTNFRII were analyzed as markers of enterocyte turnover, inflammation, and immune activation. Non-parametric tests were used for analysis. Results 52 participants born in 14 countries were enrolled February–March 2019. Median CD4 count was 464/uL [95% CI 315–598]. Fourteen (27%) were positive for Strongyloides IgG. Strongyloides IgG levels correlated positively with sCD14 levels [r=0.36; P = 0.008]. Strongyloides+ participants had significantly higher sCD14 levels compared with Strongyloides− participants [1.67 vs. 1.48 μg/mL, P = 0.031]. Among the Strongyloides+ participants, Strongyloides IgG levels correlated with sCD163 levels [r=0.65, P = 0.026]. There were no difference in the other biomarkers. Logistical regression analysis showed that predictors of Strongyloides+ include absolute eosinophil count (AEC) (OR 1.45 for every 100 increase of AEC [95% CI: 1.02, 2.15; P = 0.047]). CD4 count, number of years living in the United States, country of origin, and years from HIV diagnosis were not associated with test positivity. Conclusion Strongyloides co-infection is common among foreign-born PWH and may contribute to chronic monocyte/macrophage activation, a predictor of morbidity and mortality in PWH. Future directions include stool PCR confirmation of these infections, continued enrollment, and follow-up assays 6 months after treatment of Strongyloides to determine the impact on inflammation and risk of co-morbidities. Disclosures All authors: No reported disclosures.

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