Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Abstract

Objectives To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. Methods Two sub‐populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment‐naïve patients with CD4≥200 cells/μL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/μL without ART despite cohort follow‐up. Results Median initial CD4 cell count in group A was 331 cells/μL; 31% and 10% were <200 and <50 cells/μL, respectively. Risk factors for low CD4 count were age and non‐White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4≥200 cells/μL; 18% and 2% dropped to CD4 <200 and <50 cells/μL without ART, respectively. Sub‐Saharan origin was associated with lower probability of CD4 <200 cells/μL without ART during follow‐up. Median CD4 count at ART initiation was 207 and 253 cells/μL in groups A and B, respectively. Conclusions CD4<200 cells/μL and, particularly, CD4<50 cells/μL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

Late presenters among newly diagnosed HIV-infected in Poland in 2006-2008

“…For example, a large Swiss cohort study revealed that about 30% of patients diagnosed with CD4 T cell count below 200 cells/µl and even 10% with below 50 cells/µl [18]. The factors associated with late diagnosis in the Swiss study were increased age and non-Caucasian race, in line with observations from northern France and Brussels, Belgium [19].…”

Retraso diagnóstico de la infección por VIH

“…HTS transmission is described in different countries as an important risk factor in diagnostic delay 16,17,27,28 . It has even been observed that while in some population sub-groups the delay tends to decrease, going from 38% to 25% in 9 years, in others a constant increase can be seen 16,34 . In Barcelona, a study carried out from 2001-2009 showed a decrease in DD only in the first years of the study which then remained stable in the following years 28 .…”

“…National 27,28 and international 34,35,36 studies have associated immigration with an increase in DD. Amongst the causes explaining the delay in these groups are cultural, linguistic and socio-economic barriers, low perception of the risk of acquiring the infection and fear of stigmatisation.…”

An old enzyme for current needs: adenosine deaminase and a dendritic cell vaccine for HIV

“…For Europe as a whole, the percentage of people living with HIV who are diagnosed late in the course of infection ranges from 15% to 38% (Adler, Mounier-Jack, Coker, 2009 (Delpierre et al, 2007). In France, the USA and the United Kingdom, people with heterosexually acquired HIV infection are most likely to be diagnosed late in the course of infection (Delpierre et al, 2007;Centers for Disease Control and Prevention, 2009;Health Protection Agency, 2008), while in Switzerland being non-Caucasian was associated with late diagnosis (Wolbers et al, 2008).…”