HIV late presentation and advanced HIV disease among patients with newly diagnosed HIV/AIDS in Southwestern China: a large-scale cross-sectional study

Abstract

ObjectiveThis study aimed to investigate the prevalence of HIV late presentation and advanced HIV disease and to identify the factors associated with HIV late presentation and advanced HIV disease among patients with newly diagnosed HIV/AIDS in the Guangxi Zhuang Autonomous Region, in Southwestern China.MethodsPatients with newly diagnosed HIV registered in the HIV surveillance system of Guangxi Centers for Disease Control between January 2012 and December 2016 were included in this study.ResultsOf 45,118 newly diagnosed patients, 70.2% had late presentation, and 45.1% had advanced HIV disease. A higher prevalence of late presentation and advanced HIV disease was found in male heterosexuals and female people who use drugs (PWID). Heterosexuals (OR 2.11 [95% CI 1.90–2.34]) and PWID (OR 1.55 [95% CI 1.30–1.84]) had a higher risk of late presentation than men who have sex with men (MSM). Blood testing of the blood receivers (OR 1.75 [95% CI 1.36–2.26]) and diagnosed in hospital (OR 1.74 [95% CI 1.65–1.84]) had an increased risk of late presentation compared to those who diagnosis in voluntary counseling and testing (VCT). Heterosexuals (OR 2.86 [95% CI 2.51–3.27]), PWID (OR 2.23 [95% CI 1.83–2.71]), blood testing of the blood receivers (OR 1.58 [95% CI 1.29–1.94]) and diagnosed in hospital (OR 1.85 [95% CI 1.76–1.94]) were also independent risk factors associated with advanced HIV disease. Older age, lower level of education and being divorced or widowed were also associated with late presentation and advanced HIV disease.ConclusionsLate presentation and advanced HIV disease were very common among patients with newly diagnosed HIV in Guangxi, China during 2012–2016. Targeted programs are urgently required to reduce HIV late diagnosis in Guangxi, especially for male heterosexuals, PWID, and patients with characteristics such as older age, lower level of education, divorced or widowed.

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

“…Previous studies have shown that patients with a late diagnosis of HIV infection had a higher risk of mortality than those with an early HIV diagnosis [34], and universal ART among late presentation patients reduced mortality by just 10% [35]. Late presentation is de ned well as, a patient diagnosed with the rst CD4 + cell count < 350/μL, or a patient with AIDS-de ning illness regardless of CD4 + cell count during diagnosis [8,[36][37]. In this study, the median CD4 + cell count in the ADE group was 29.00 cells/ μL (IQR: 12.00-116.50), and 96.05% of patients with ADE had late presentation, demonstrating that most of patients with ADE were in an advanced stage of HIV/AIDS.…”

“…The "Treat for All" policy was implemented in 2016, and HIV positive individuals would be treated after diagnosis of HIV regardless of their CD4 + cell count [5][6][7]. However, research showed that 45.1% patients in the advanced stages of AIDS when they were diagnosed [8], which might be the main reason for the high mortality rate in HIV positive individuals, even when they are on ART.…”

HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months

“…However, throughout the period of increasing implementation of ART, China's National Free Antiretroviral Treatment Program (NFATP) has been largely successful, with an overall reduction in virological failure and HIV drug resistance since 2008 [9]. Although there is limited access to many antiretrovirals (ARVs) in China, data from the NFATP study prove that understanding the scientific basis and clinical implications of HIVDR is useful in order to shape appropriate surveillance, inform treatment algorithms, and manage difficult cases [9][10][11][12].…”

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in southwestern China: a cohort study

“…The "Treat for All" policy was implemented in 2016, and HIV positive individuals would be treated after diagnosis of HIV regardless of their CD4 + cell count [5][6][7] . However, research showed that 45.1% patients were in the advanced stages of AIDS when they were diagnosed [8] , which might be the main reason for the high mortality rate in HIV positive individuals, even when they are on ART.…”

“…Late diagnosis and delayed treatment of HIV infection contribute to the development of opportunistic infections, such as pneumocystis pneumonia, Talaromyces marneffei infection, etc. In Guangxi, a recent retrospective study revealed that 70.2% of newly diagnosed HIV cases from 2012 to 2016 had a late presentation, and 45.1% had advanced HIV disease [8] . Most of patients with late presentation, advanced HIV disease, or ADE have relatively low CD4 + cell counts or develop AIDS symptoms.…”