In the era of highly active antiretroviral therapy, why are HIV‐infected patients still admitted to hospital for an inaugural opportunistic infection?

Abstract

ObjectivesTo identify factors related to delayed testing, and delayed or interrupted care-seeking or treatment uptake, among HIV-infected patients. DesignHIV-infected patients hospitalized for an opportunistic infection (OI) cases were included in a prospective study and compared with controls matched by age and sex who had regular follow-up and treatment. Patients were asked to complete a questionnaire about their therapeutic itinerary and their socioeconomic, psychological and medical characteristics. ResultsSeventy patients were matched with 140 controls. According to their therapeutic itinerary prior to admission, cases were subdivided into four groups among which three will be more particularly studied: nontested patients (NT) (24%; n 5 17), known HIV-infected patients with no medical followup (NF) (30%; n 5 21); and noncompliant patients (NC) (36%, n 5 25). Characteristics of NT and NF patients included a predominantly sexual mode of contamination (P 5 0.01), continuing occupational activity (P 5 0.01) despite a low mean Karnofsky index (P 5 0.001) and unfavourable virological and immunological parameters. NT patients displayed a low degree of anxiety, and lacked awareness concerning risk of contamination and HIV-related symptoms. HIV-status announcement (P 5 0.04) and the benefits of medical follow-up (P 5 0.05) were less favourably perceived by NF patients than by controls, and were associated with a high degree of anxiety in NF patients. NC patients had a weaker commitment to follow-up and treatment, and more frequent treatment discontinuation associated with a higher rate of interruption of follow-up in a context of social difficulties. ConclusionsPatients ignorant of their HIV status, patients NF and NC have very specific characteristics. More appropriate approaches are needed regarding screening and access to care in order to reduce the incidence of delayed care-seeking.

Activation, exhaustion, and persistent decline of the antimicrobial MR1-restricted MAIT-cell population in chronic HIV-1 infection

“…Despite considerable advances in the treatment and management of HIV-1 disease, certain infections still present a significant clinical challenge particularly among HIV-infected individuals who are diagnosed at advanced stages, those who lack access to antiretroviral therapy, and those who cannot maintain adherence to therapy and clinical care. [18][19][20] This includes an increased risk of developing bacterial pneumonia even in HIV-1-infected patients with relatively normal CD4 counts, 21 indicating that impaired CD4 T-cell independent control of certain infections still exists even in the context of treated HIV-1 disease. Mucosal-associated invariant T (MAIT) cells are a relatively recently discovered subset of unconventional, innate-like T cells that are highly abundant in mucosal tissues, liver, and peripheral blood.…”

“…Despite considerable advances in the treatment and management of HIV-1 disease, certain infections still present a significant clinical challenge particularly among HIV-infected individuals who are diagnosed at advanced stages, those who lack access to antiretroviral therapy, and those who cannot maintain adherence to therapy and clinical care. [18][19][20] This includes an increased risk of developing bacterial pneumonia even in HIV-1-infected patients with relatively normal CD4 counts, 21 indicating that impaired CD4 T-cell independent controlthe expression of CD161, the IL-18 receptor (IL-18R), and the transcription factor ZBTB16, also known as PLZF. [26][27][28] The majority of MAIT cells are CD8 ϩ , expressing either CD8␣␣ or CD8␣␤, with minor CD4 ϩ or CD8/4 double-negative populations.…”

Treatment and Prevention of Cytomegalovirus-Associated Diseases in HIV-1 Infection in the Era of HAART

“…Other patients who present with opportunistic infections are those who are aware of their illness but fail to receive adequate treatment and care [271,272]. Reasons for this may include psychosocial and socioeconomic factors, such as increasing copayments for medications that cannot be afforded by low income groups in addition to higher bureaucratic hurdles that have been set up by some healthcare providers that exclude patients with lower educational status, migratory background and/or older patients with dementia who might not be able to comply with the required documentation to receive the benefits, even in developed countries such as Germany, among others [269,270].…”

“…Despite the successful introduction of HAART in the USA and western Europe, a substantial proportion of HIV-infected individuals in these countries are not aware of their infection and present late in their disease with substantially decreased CD4 + T-cell counts and similar patterns of opportunistic infections as compared with the pre-HAART area (so-called 'late presenter') [267][268][269][270]. In these patients Pneumocystis jirovecii is the most frequent manifestation; however, CMV end-organ diseases causes a significant morbidity in this population similar to that in the early epidemic [67].…”

HIV counselling and testing in secondary schools: What students want

“…1,2,3,4,5 However, despite a national HCT campaign from 2010 to 2012 in South Africa, only 50.6% of youth aged 15-24 years reported testing, compared with 78.2% of adults aged 25-49 years. 6 As part of the national HCT campaign, the South African Departments of Basic Education and Health announced that they intended to launch an HCT campaign specifically targeting secondary school students.…”