Correlates of Late Presentation to HIV care in a South Indian Cohort

Abstract

Late presentation to healthcare by HIV infected patients' is common in India despite access to free combination antiretroviral therapy (cART). We assessed risk factors for late presentation among patients with a recent HIV diagnosis in an academic university-based antiretroviral treatment center. This retrospective study included 474 recently diagnosed HIV-infected patients registered for cART between 2012 and 2013. Subjects with CD4 T-lymphocyte (CD4) count ≤ 350 cells/μL or with an AIDS defining event were defined as late presenters (LP) and patients with CD4 count ≤ 200 cells/μL or with an AIDS defining event were defined as LP with advanced HIV disease (LPAD). Multivariable logistic regression analysis was used to investigate factors associated with late presentation. Of the 474 patients, 356 (75.1%) were LP. Of these, 299 (83.99%) were LPAD and 57 (16.01%) LP were AIDS-free. Median CD4 count among LP was 134 cells/μL (interquartile range 72.25-219). Mean age of LP was 42.50 ± 8.88 years; 256 (71.9%) were males. Increasing age (> 51 years; Adjusted odds ratio [aOR] 4.19; = 0.014) and rural residence (aOR 3.19; = < 0.001) were independently associated with late presentation. HIV-positive housewives (aOR 0.34; = 0.027), HIV-positive individuals with negative partners (aOR 0.48; = 0.006), and partners with unknown HIV status (aOR 0.43; = 0.007) were less likely to present late compared with positive partners of people living with HIV/AIDS (PLWHA). Most patients were LP despite free access to cART. Rural population and older PLWHA should be targeted while implementing HIV care. There is a need to strengthen the HIV care cascade by linking PLWHA to cART immediately after diagnosis.

Determinants of Late HIV Presentation at Ndlavela Health Center in Mozambique

“…Although women are, in Africa, more vulnerable to acquiring HIV, in this study, we found that men were more likely to have late presentations, compared with women. Similar results were found in previous studies carried out in South Africa [19], India [24], sub-Saharan Africa [25], Switzerland [26], Asia [27], Ethiopia [28], Benin [29], and Asia [15].…”

Prevalência do Vírus da Imunodeficiência Humana e fatores associados em gestantes no estado do Pará

“…A análise do perfil sociodemográfico da amostra evidenciou características semelhantes a outros estudos que avaliaram mulheres com HIV (14)(15)(16) , com predomínio da faixa etária 20-30 anos, raça parda, em união estável, com ensino regular completo e donas de casa. Diante da feminização da epidemia do HIV, fatores socioeconômicos podem atuar como determinantes para a infecção, já que grande parte das mulheres infectadas ainda se encontra em idade fértil (14) , possui menor nível de escolaridade, vive em união estável (17) , é parda (18) e dona de casa (19) .…”

Prevalence of the Human Immunodeficiency Virus and associated factors in pregnant women in the state of Pará

“…The analysis of the sociodemographic profile of the sample showed characteristics similar to other studies that evaluated women with HIV ( 14 , 15 , 16 ) ; predominance of the age group 20-30 years, mixed race, in a common-law marriage, complete regular education and housewives. Given the feminization of the HIV epidemic, socioeconomic factors can act as determinants for the infection, since most infected women were still of childbearing age ( 14 ) , in a common-law marriage ( 17 ) , mixed race ( 18 ) , housewives ( 19 ) and have a low level of education.…”