Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

Abstract

BackgroundOur objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages.MethodsWe collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing.ResultsOf the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003.ConclusionA considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups.

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]. The second factor with its potential implication can be excluded in regard of the presented population since only the Caucasian patients were evaluated.…”

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“…Des études ont montré que le nombre de lymphocytes T CD4 à la mise sous TARV est le plus important facteur pré-dictif de la progression de la maladie, notamment des complications infectieuses et de la survie des patients après la mise sous TARV (24). Le taux médian de CD4 dans cette étude à la mise sous TARV était de 177 cellules/mm 3 et on notait que 56,4 % des patients mis sous TARV à la période d'étude l'avaient initié avec des CD4 inférieurs à 200 cellules/mm 3 .…”

“…En Afrique de l'Ouest, Bashi et al avaient retrouvé 139 cellules/mm 3 (3) tandis que Mouhari-Touré notait 138 cellules/ mm 3 en 2009 (22). Cela pose le problème du diagnostic et celui de la prise en charge tardive des patients en Afrique subsaharienne, expliquant la mortalité initiale très élevée à la mise sous TARV (24). Par contre dans les pays dévelop-pés, l'initiation du TARV est relativement plus précoce.…”

“…Les facteurs associés à l'initiation tardive dans cette étude étaient le sexe masculin, l'âge et le délai du diagnostic. Ces mêmes facteurs avaient été retrouvés au Cameroun par Ndawinz et al et en France par Ndiaye et al (23,24). Les patients de sexe masculin initient le TARV à un stade avancé de la maladie par rapport aux patients de sexe féminin et plus l'âge augmente, plus le patient présente le risque d'initier tardivement le TARV (23).…”

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“…Estadísticas señalan que entre 22 y 83% de las personas infectadas por VIH fueron diagnosticadas en etapa de SIDA en Europa y Estados Unidos de Améri-ca [2][3][4][5][6] . Esta tendencia se mantiene en Chile, en el año 2008, 9.193 personas fueron diagnosticadas en etapa de SIDA 7 , representando 46% de las infectadas por VIH 8 .…”