Abstract:BackgroundTimely access to antiretroviral therapy is a key to controlling HIV infection. Late diagnosis and presentation to care diminish the benefits of antiretrovirals and increase risk of transmission. We aimed to identify late presenters in patients sent for first CD4 T cell count after HIV diagnosis, for therapy initiation evaluation. Further we aimed at identifying patient factors associated with higher risk of late presentation.MethodsRetrospective data collection and analysis was done for 3680 subjects… Show more
“…Some attribution to this occurrence could be that older patients are more likely to be diagnosed with HIV and/or TB late. It is well acknowledged that late diagnosis facilitates poor prognosis and deaths due to immune deficiency from rapid progression to Acquired Immune Deficiency Syndrome (AIDS) and extra-pulmonary tuberculosis [25–28]. This has implications for practice indicating the heightened need for early diagnosis and treatment of both HIV and TB.…”
BackgroundTuberculosis/HIV co-infection is a bidirectional and synergistic combination of two very important pathogens in public health. To date, there have been limited clinical data regarding mortality rates among tuberculosis/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in Ethiopia. This study assessed the incidence and predictors of tuberculosis/HIV co-infection mortality in Southwest Ethiopia.MethodsA retrospective cohort study collated tuberculosis/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used proportional hazards cox regression model at P value of ≤ 0.05 in the final model.ResultsFifty-five (20.2 %) patients died during the study period and 272 study participants contributed 3 082.7 person month observations. Factors including: being aged between 35–44 years (AHR = 2.9; 95 % CI: 1.08–7.6), being a female sex worker (AHR = 9.1; 95 % CI: 2.7–30.7), being bed ridden as functional status (AHR = 3.2; 95 % CI: 1.2–8.7), and being at World Health Organization HIV disease stages 2 (AHR = 0.2; 95 % CI: 0.06–0.5), 3(AHR = 0.3; 95 % CI: 0.1–0.8) and 4(AHR = 0.2; 95 % CI: 0.04–0.55) were significant predictors of mortality for tuberculosis/HIV co-infected patients.ConclusionsContrary to our expectations, the World Health Organization (WHO) HIV disease stage 1 was found to be a significant predictor of mortality. Higher mortality rates were observed in WHO disease stage 1 patients compared to patients in stages 2, 3 and 4. The current study also confirmed and reaffirmed known significant predictors of the mortality for tuberculosis/HIV co-infected patients including being 35–44 years, being a female sex worker and being bed ridden functional status. The occurrence of high death rate among tuberculosis/HIV co-infected cases needs actions to reduce this poor outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0202-1) contains supplementary material, which is available to authorized users.
“…Some attribution to this occurrence could be that older patients are more likely to be diagnosed with HIV and/or TB late. It is well acknowledged that late diagnosis facilitates poor prognosis and deaths due to immune deficiency from rapid progression to Acquired Immune Deficiency Syndrome (AIDS) and extra-pulmonary tuberculosis [25–28]. This has implications for practice indicating the heightened need for early diagnosis and treatment of both HIV and TB.…”
BackgroundTuberculosis/HIV co-infection is a bidirectional and synergistic combination of two very important pathogens in public health. To date, there have been limited clinical data regarding mortality rates among tuberculosis/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in Ethiopia. This study assessed the incidence and predictors of tuberculosis/HIV co-infection mortality in Southwest Ethiopia.MethodsA retrospective cohort study collated tuberculosis/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used proportional hazards cox regression model at P value of ≤ 0.05 in the final model.ResultsFifty-five (20.2 %) patients died during the study period and 272 study participants contributed 3 082.7 person month observations. Factors including: being aged between 35–44 years (AHR = 2.9; 95 % CI: 1.08–7.6), being a female sex worker (AHR = 9.1; 95 % CI: 2.7–30.7), being bed ridden as functional status (AHR = 3.2; 95 % CI: 1.2–8.7), and being at World Health Organization HIV disease stages 2 (AHR = 0.2; 95 % CI: 0.06–0.5), 3(AHR = 0.3; 95 % CI: 0.1–0.8) and 4(AHR = 0.2; 95 % CI: 0.04–0.55) were significant predictors of mortality for tuberculosis/HIV co-infected patients.ConclusionsContrary to our expectations, the World Health Organization (WHO) HIV disease stage 1 was found to be a significant predictor of mortality. Higher mortality rates were observed in WHO disease stage 1 patients compared to patients in stages 2, 3 and 4. The current study also confirmed and reaffirmed known significant predictors of the mortality for tuberculosis/HIV co-infected patients including being 35–44 years, being a female sex worker and being bed ridden functional status. The occurrence of high death rate among tuberculosis/HIV co-infected cases needs actions to reduce this poor outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0202-1) contains supplementary material, which is available to authorized users.
“…Published national program data of 972 patients at three government ART centres from 2004 to 2005 showed nearly 75% of patients had CD4 cell count <200 cells/mm 3 at the time of initiation of ART [4]. In New Delhi, India from 2001 to 2007, 33% (n=3680) of patients first presented at CD4 cell count below 200 cells/mm 3 with 9.5% subjects having CD4 cell count below 50 cells/uL [21]. According to published national program data reporting baseline CD4 cell count of 116,225 registered HIV-infected persons from 2005 to 2008, 85% registered for ART with baseline CD4 cell count less than 200 cells/mm 3 [5].…”
SettingTwelve antiretroviral treatment centres under National AIDS Control Programme (NACP), Karnataka State, India.ObjectiveFor the period 2004-2011, to describe the trends in the numbers of people living with HIV (PLHIV) registered for care and their median baseline CD4 counts, disaggregated by age and sex.DesignDescriptive study involving analysis of routinely captured data (year of registration, age, sex, baseline CD4 count) under NACP.Results34,882 (97% of total eligible) PLHIV were included in analysis. The number registered for care has increased by over 12 times during 2004-11; with increasing numbers among females. The median baseline CD4 cell count rose from 125 in 2004 to 235 in 2011 – the increase was greater among females as compared to males. However, about two-thirds still presented at CD4 cell counts less than 350.ConclusionWe found an increasing trend of median CD4 counts among PLHIV presenting to ART centres in Karnataka, an indicator of enhanced and early access to HIV care. Equal proportion of females and higher baseline CD4 counts among them allays any fear of differential access by gender. Despite this relative success, a substantial proportion still presented at low CD4 cell counts indicating possibly delayed HIV diagnosis and delayed linkage to HIV care. Universal HIV testing at health care facilities and strengthening early access to care are required to bridge the gap.
“…Late diagnosis has generally been found to be more common among men and older adults in multiple studies in the US, Australia, Europe, and Asia. 13,28,[41][42][43][44][45][46][47][48][49][50][51] Health care providers may be less likely to consider HIV infection in an older adult, and older adults may perceive themselves as at lower risk than younger adults. 51 Rapid disease progression, which would appear as a late diagnosis, has been reported in older adults.…”
The purpose of this retrospective cohort study was to identify individual-level demographic and communitylevel socioeconomic and health care resource factors associated with late diagnosis of HIV in rural and urban areas of Florida. Multilevel modeling was conducted with linked 2007-2011 Florida HIV surveillance, American Community Survey, Area Health Resource File, and state counseling and testing data. Late diagnosis (defined as AIDS diagnosis within 3 months of HIV diagnosis) was more common in rural than urban areas (35.8% vs. 27.4%) ( p < 0.0001). This difference persisted after controlling for age, sex, race/ethnicity, HIV transmission mode, country of birth, and diagnosis year (adjusted OR 1.39; 95% CI 1.17-1.66). In rural areas, older age and male sex were associated with late HIV diagnosis; zip code-level socioeconomic and county level health care resource variables were not associated with late diagnosis in rural areas. In urban areas only, Hispanic and non-Hispanic black race/ethnicity, foreign birth, and heterosexual mode of transmission were additionally associated with late HIV diagnosis. These findings suggest that, in rural areas, enhanced efforts are needed to target older individuals and men in screening programs and that studies of psychosocial and structural barriers to HIV testing in rural and urban areas be pursued.
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