Imputation of the Date of HIV Seroconversion in a Cohort of Seroprevalent Subjects: Implications for Analysis of Late HIV Diagnosis

Sobrino-Vegas, Paz; Pérez-Hoyos, Santiago; Geskus, Ronald B.; Padilla, Belén; Segura, Ferrán; Rubio, Rafael; Romero, Jorge del; Santos, Jesús; Moreno, Santiago; Amo, Julia del

doi:10.1155/2012/725412

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Despite the strong reduction of the HIV epidemic among IDU in Italy since 1990 [19], our results evidence a high proportion of LP and the highest proportion of persons with AHD among IDU; similar results were reported in a study conducted in Spain [20]. These findings can be explained by a lower HIV testing uptake in drug-treatment centers in the last decade [21] mainly attributable to the decline in HIV prevalence among IDU [22] and in the number of persons who inject drugs [21].…”

Section: Discussionsupporting

confidence: 89%

Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

Camoni¹,

Raimondo²,

Règine³

et al. 2013

BMC Public Health

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BackgroundIn Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010–2011.MethodsWe used individual data on new HIV diagnoses reported by the HIV surveillance system in 2010 and in 2011. Persons with CD4 ≤350 cells/μL or diagnosed with AIDS (regardless of the CD4 cell count) were defined as late presenters (LP); persons with CD4 ≤ 200 cells/μL or AIDS (regardless of the CD4 cell count) were defined as presenting with advanced HIV disease (AHD).ResultsOf the 7,300 new diagnoses reported in 2010–2011 by the included regions, 55.2% were LP; among these, 37.9% was diagnosed with AIDS. Persons presenting with AHD were 37.8%.The median age of LP was 40 years (IQR 33–48), significantly higher (p < 0.001) than that of non-LP (35 years); 73.9% were males; 30.7% were non-nationals. The median age of AHD was 42 years (IQR 35–50), 74.5% were males; 31.1% were non-nationals.The proportion of LP among IDUs was 59.8%, among heterosexuals (HET) 61.1% and among MSM 44.3%. The proportion of AHD among IDUs was 43.6%, among HET 43.2% and among MSM 27.4%.Factors significantly associated with being LP were: age older than 50 years (OR = 4.6 [95% CI 3.8-5.6]); having been diagnosed in Southern Italy (Southern vs Northern Italy OR = 1.5 [95% CI 1.3-1.7]) having been diagnosed in Central Italy (Central vs Northern Italy OR = 1.3 [95% CI 1.1-1.6]); being HET (HET vs MSM, OR = 1.7 [95% CI 1.5-2.0]), being non-national (Non-national vs Italian, OR 1.7 (95% CI 1.5-2.0); being IDU (IDU vs MSM, OR = 1.6 [95% CI 1.2-2.1]). The same factors were significantly associated with being AHD.ConclusionsOlder people, people diagnosed in Central and Southern Italy, non nationals, and persons who acquired the infection through injecting drug use or heterosexual contact showed a higher risk of being diagnosed late. A more active offer of HIV testing and targeted interventions focussed on these populations are needed to optimize early access to care and treatment.

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Section: Discussionsupporting

confidence: 89%

Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

Camoni¹,

Raimondo²,

Règine³

et al. 2013

BMC Public Health

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“…Loss to follow‐up was also higher in patients with better clinical status, so the residual bias, if any, would tend to overestimate incidence rates in migrants. Finally, selection bias could have been present in the DD analysis, as this was restricted to newly diagnosed patients recruited to the cohort, the implications of which were discussed in a previous publication for this cohort . The results of this study indicate different sources of inequality in HIV management and disease progression which are important for public health policies and service planning and delivery.…”

Section: Discussionmentioning

confidence: 87%

Inequalities in HIV disease management and progression in migrants from Latin America and sub‐Saharan Africa living in Spain

et al. 2012

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ObjectivesThe objective of the study was to analyse key HIV-related outcomes in migrants originating from Latin America and the Spanish-speaking Caribbean (LAC) or sub-Saharan Africa (SSA) living in Spain compared with native Spaniards (NSP). MethodsThe Cohort of the Spanish AIDS Research Network (CoRIS) is an open, prospective, multicentre cohort of antiretroviral-naïve patients representing 13 of the 17 Spanish regions. The study period was 2004-2010. Multivariate logistic or Fine and Gray regression models were fitted as appropriate to estimate the adjusted effect of region of origin on the different outcomes. ResultsOf the 6811 subjects in CoRIS, 6278 were NSP (74.2%), LAC (19.4%) or SSA (6.4%). For these patients, the follow-up time was 15870 person-years. Compared with NSP, SSA and LAC under 35 years of age had a higher risk of delayed diagnosis [odds ratio (OR) 2.0 (95% confidence interval (CI) 1.5-2.8) and OR 1.7 (95% CI 1.4-2.1), respectively], as did LAC aged 35-50 years [OR 1.3 (95% CI 1.0-1.6)]. There were no major differences in time to antiretroviral therapy (ART) requirement or initiation. SSA exhibited a poorer immunological and virological response [OR 0.8 (95% CI 0.7-1.0) and OR 0.7 (95% CI 0.6-0.9), respectively], while no difference was found for LAC. SSA and LAC showed an increased risk of AIDS for ages between 35 and 50 years [OR 2.0 (95% CI 1.1-3.7) and OR 1.6 (95% CI 1.1-2.4), respectively], which was attributable to a higher incidence of tuberculosis. However, no statistically significant differences were observed in mortality. ConclusionsMigrants experience a disproportionate diagnostic delay, but no meaningful inequalities were identified regarding initiation of treatment after diagnosis. A poorer virological and immunological response was observed in SSA. Migrants had an increased risk of AIDS, which was mainly attributable to tuberculosis.

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“…Some surrogates previously used include down-regulation of CD127 on CD4 cells and the degree of immune activation. A recent study from Nigeria estimated the time between HIV seroconversion and diagnosis to be 6.1 years for men and 7.3 years for women [40][41][42][43]. Using the formula derived in that study, the probable time from seroconversion to presentation for care among our patients would be 2.3 years for men and 2.6 years for women.…”

Section: Percentage Of Patientsmentioning

confidence: 98%

Patients who present late to HIV care and associated risk factors in Nigeria

Agaba

Sule

et al. 2014

HIV Medicine

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ObjectivesOur objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. MethodsWe conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health− President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. ResultsAmong 14 487 eligible patients, 12 401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). ConclusionsEfforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.

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Imputation of the Date of HIV Seroconversion in a Cohort of Seroprevalent Subjects: Implications for Analysis of Late HIV Diagnosis

Cited by 6 publications

References 24 publications

Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

Inequalities in HIV disease management and progression in migrants from Latin America and sub‐Saharan Africa living in Spain

Patients who present late to HIV care and associated risk factors in Nigeria

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