Routine testing to reduce late HIV diagnosis in France

Delpierre, Cyrille

doi:10.1136/bmj.39225.458218.94

Cited by 37 publications

(24 citation statements)

References 16 publications

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“…The same may hold for other countries in Europe and North America, where the median CD4 at start of ART is low [28]. In view of the marked differences in mortality when comparing late-presenting individuals to those presenting earlier, our results argue in favour of expanded HIV testing [29][30][31]. These arguments are complemented by our results, which demonstrate that in individuals with timely HIV diagnosis ART is initiated promptly before a further drop of CD4 T-cells.…”

Section: Discussionsupporting

confidence: 74%

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Wolbers¹,

Bucher²,

Furrer³

et al. 2008

HIV Medicine

110

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Objectives To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. Methods Two sub‐populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment‐naïve patients with CD4≥200 cells/μL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/μL without ART despite cohort follow‐up. Results Median initial CD4 cell count in group A was 331 cells/μL; 31% and 10% were <200 and <50 cells/μL, respectively. Risk factors for low CD4 count were age and non‐White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4≥200 cells/μL; 18% and 2% dropped to CD4 <200 and <50 cells/μL without ART, respectively. Sub‐Saharan origin was associated with lower probability of CD4 <200 cells/μL without ART during follow‐up. Median CD4 count at ART initiation was 207 and 253 cells/μL in groups A and B, respectively. Conclusions CD4<200 cells/μL and, particularly, CD4<50 cells/μL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

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Section: Discussionsupporting

confidence: 74%

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Wolbers¹,

Bucher²,

Furrer³

et al. 2008

HIV Medicine

110

View full text Add to dashboard Cite

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“…Another French study found that being in a steady relationship and having children make people feel that they are less at risk for HIV and cause them to be at greater risk for late diagnosis (Delpierre et al, 2006). Generally speaking, since they are not priority targets for testing, current French policy results in people at low risk for HIV infection being at high risk for late detection (Delpierre, Cuzin, & Lert, 2007).…”

Section: Discussionmentioning

confidence: 99%

Gender, socio-economic status, migration origin and neighbourhood of residence are barriers to HIV testing in the Paris metropolitan area

et al. 2011

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“…Broadly, rates of late diagnosis have either remained the same or increased [6]. Confronted with substantial numbers of individuals who are unaware of their HIV status, there have been calls in a number of countries in Europe for an increase in HIV testing as well as an extension of provider-initiated routine opt-out testing [7,8].…”

Section: Discussionmentioning

confidence: 99%

HIV testing strategies across European countries

2008

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With universal access to effective combination antiretroviral therapy (ART), people in need can gain effective treatment but are only able to benefit from these advances if they are aware of their serostatus and have effectively accessed testing services. Despite the expectation that ART would lead individuals to seek earlier testing, this trend has not been observed in practice, with stable or even increasing rates of late diagnosis in Europe being witnessed. Ahead of a gathering of key European stakeholders in Brussels in November 2007, we reviewed testing strategies across European countries. We show differences in policy and practices. Moreover, HIV testing strategies are changing, in line with new global guidelines issued by World Health Organization headquarters, and a number of countries are promoting an expansion of routine and opt-out testing. However, gaps in our understanding of effective testing strategies remain and, as a consequence, national policies across Europe remain incoherent and often lack an evidence base. This is likely to have serious public health implications.

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Routine testing to reduce late HIV diagnosis in France

Abstract: Although around half the French population has had an HIV test, many people are still not diagnosed until the disease is advanced. Cyrille Delpierre and colleagues believe the answer is to expand routine testing

Cited by 37 publications

References 16 publications

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Gender, socio-economic status, migration origin and neighbourhood of residence are barriers to HIV testing in the Paris metropolitan area

HIV testing strategies across European countries

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