Long‐term trends in HIV care entry: over 15 years of clinical experience from Poland

Abstract

Introduction Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. Methods Cross‐sectional data were collected for 3972 HIV‐infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000–2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/μL or history of AIDS‐defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/μL or history of AIDS) were identified. Results The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46–4.47] for late presentation and 3.13 (95% CI 1.49–6.58) for advanced disease for the 21–30‐year‐old category to 5.2 (95% CI 1.94–14.04) and 8.15 (95% CI 2.88–23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16–2.60) and 1.55 (95% CI 1.05–2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31–0.59) and 0.39 (95% CI 0.29–0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. Conclusions Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland – data from Test and Keep in Care (TAK) Polska project

“…A comparison of the results presented by Siwak et al . [19] with the findings of this study shows a decrease in the number of people having AIDS at HIV diagnosis in all transmission groups. In 2000–2015 Siwak et al .…”

“…However, the decreasing number of LP among MSM (from 49.4% in Siwak et al . [19] to 39.7% in this study) may reflect an increased awareness and more frequent testing [19].…”

“…In the period 2000–2015, Siwak et al . [19] reported a decrease of LP from 67.6% in 2000 to 53.5% in 2015 (35.6% with advanced disease), and Wójcik et al . [20], in a single‐centre study, showed that, in the years 2009–2016 in Lodz, 62.86% of all newly diagnosed patients were LP (43.2% late presenters with advanced disease) with a sharp decrease in LP to 50.9% in 2016.…”

“…In 2000–2015 Siwak et al . [19] showed that having AIDS at HIV diagnosis was recognized in 25.95% of MSM, 48.3% of IDU and 45.4% of HTX. In our study these proportions were lower and amounted to 8.5%, 32.4% and 18%, respectively, as well as 12.8% among patients with an unknown route of transmission.…”

“…Regarding the MSM group and the lower percentage of MSM diagnosed at the late stage of HIV infection, it should be noted that this trend parallels the number of people newly infected via this route [18,19]. New infections among MSM seem more often to be the result of a very rapid HIV circulation during chemsex and circuit parties; as shown by Parczewski et al .…”