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

Abstract

<jats:p> 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 (&gt;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 &lt; 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6–2.7, p &lt; 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. </jats:p>

Real-world data in late presentation of HIV infection in Suzhou, China: Results from four consecutive cross-sectional surveys, 2017–2020

“…Besides, psychological factors, such as stigma, are more common in older people, which may also impede access to health services including HIV testing. Different from some studies ( 12 , 18 , 27 ), we did not observe any impact of gender.…”

“…In our study, high percentages of late presentation were shown over the time, with more than half each year. It is higher than that in some countries of Europe (14, [19][20][21][22], Australia (17), and the United States (23), lower than that in Panama (18), South Africa (24,25), Ethiopia (26), and Guangxi of China (12), and similar to that in Iran (27). It is important to notice that higher percentages of late presentation were indicated among people over 40 years old, retirees, farmers, married, heterosexuals, and people registered in Suzhou in our study.…”

“…In recent years, there had been decreasing trends among late presenters in Turkey ( 14 ), Kinshasa of DRC ( 15 ), and the East of England ( 16 ). In addition, trends in late presentation of HIV infection remained relatively stable in Australia ( 17 ), Panama ( 18 ), and Guangxi of China ( 12 ). Over the past dozen years, several HIV testing promotion measures and strategies have been widely used in medical institutions in China.…”

Evaluation of the late presentation and associated factors of people living with HIV in Turkey

“…Age distribution of patients (median [IQR]: 31 years [26−39]) in this study was consistent with the latest national HIV/AIDS statistics which showed that patients with HIV/AIDS were diagnosed at a slightly younger age (one‐third between 25 and 34 years) in Turkey than in Europe (median: 33 [27−41]) 41,42 . Age at diagnosis >30 years was an independent determinant of both late presentation and presentation with advanced disease in line with other studies reporting an association between older age (lower limits varying between 20 and 45) and late presentation 15–28 . Contrastingly, a study from Sudan reported that younger people were more likely to present late 31 …”

“…However, like many studies including the analysis of the large EuResist database (1981−2019 data), which included approximately 90 000 patients from seven European countries sex was not a factor for late presentation 17–23 . Contrastingly, several studies from various geographies reported an association between male sex and late presentation to HIV/AIDS care 24–29 . There were also few studies where female sex a factor for late presentation was to care 30,31 .…”