Ten-year trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic

Easterbrook, Philippa; Yu, Ly-Mee; Goetghebeur, Els; Boag, Fiona; McLean, Ken; Gazzard, Brian

doi:10.1097/00002030-200003310-00012

Cited by 41 publications

(20 citation statements)

References 15 publications

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“…Association of higher age groups of 35-44 years ages 45 years and above seen in our study with late and very late presentation to care has been emphasized in literature [19,22,23]. Homosexual transmission route has been reported to be associated with a lesser risk of late presentation in previous studies [23,24].…”

Section: Discussionsupporting

confidence: 70%

Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population

et al. 2010

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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 visiting the laboratory for CD4 T cell counts between 2001 and 2007. We segregated the patients on basis of their CD4 T cell counts after first HIV diagnosis. Factors associated with risk of late presentation to CD4 T cell counts after HIV diagnosis were identified using univariate analysis, and the strength of association of individual factor was assessed by calculation of odds ratios.ResultsOf 3680 subjects, 2936 (83.37%) were defined as late presenters. Late testing varied among age groups, transmission categories, and gender. Males were twice as likely to present late as compared to females. We found significant positive association of heterosexual transmission route (p < 0.001), and older age groups of 45 years and above (p = 0.0004) to late presentation. Female sex, children below 14 years of age and sexual contact with HIV positive spouse were associated with significantly lower risks to presenting late. Intravenous drug users were also associated with lower risks of late presentation, in comparison to heterosexual transmission route.ConclusionsThe study identifies HIV infected population groups at a higher risk of late presentation to care and treatment. The risk factors identified to be associated with late presentation should be utilised in formulating targeted public health interventions in order to improve early HIV diagnosis.

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Section: Discussionsupporting

confidence: 70%

Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population

et al. 2010

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“…25 Literature on the topic emphasizes several factors that may be associated with delay in initiating therapy, among them, risk category (especially heterosexuals), age (especially older adults), sex (males, since women are often tested during pregnancy), as well as other cultural, political, and economic factors. 17,19,26 In Brazil, women of reproductive age are routinely screened for HIV during pregnancy, as recommended by the Ministry of Health. Detection of HIV infection during prenatal care also promotes the early detection of infected partners, generally in the under-50 age group.…”

Section: Discussionmentioning

confidence: 99%

Delay in Introducing Antiretroviral Therapy in Patients Infected by Hiv in Brazil, 2003-2006

Souza-Jr

Szwarcwald

Castilho³

2007

Clinics

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Souza-Jr, PRB, Szwarcwald CL, Castilho EA. Delay in introducing antiretroviral therapy in patients infected by HIV in Brazil, 2003. Clinics. 2007 62(5):579-84. PURPOSE:To characterize the population of HIV+ Brazilian patients with late introduction of antiretroviral therapy (ARVT), using information from the Laboratory Exam Control System. METHODS: The study analyzed 84,694 patients, representing all individuals in Brazil age 15 or over with an initial CD4 + T lymphocyte count requested between 2003 and 2006, and whose ARVT start date was later than their initial CD4 + T cell count. These patients were considered antiretroviral treatment naive. The initial CD4 + T cell distribution was analyzed according to sex, age, region and year. RESULTS: Most of the patients were between 15 and 49 years of age (91%); 56% were males; 76% were asymptomatic; 50% lived in the Southeastern region of the country, with an additional 20% in the South. Initial CD4 + counts for one-third of the patients were less than 200 cells/mm 3 . When combined with the number of symptomatic individuals, 41% of the total group was in need of immediate ARVT. This group included 47% of the men and 53% of the patients aged 50 years and over. CONCLUSIONS: Despite universal access to ARVT in Brazil, results show that a high proportion of patients initiate ARVT at an advanced stage of disease, indicating the need to develop strategies to promote early diagnosis of HIV infection nationwide.

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“…In particular, increased CD4 counts over time may result from an increase in the number of newly diagnosed individuals with high CD4 counts attending the centres in the collaboration. However, results from the CD4 surveillance scheme in the United Kingdom12 and from individual cohorts in the collaboration13 14 indicate that this is not the case. A second concern is that as this is a dynamic cohort, patients may leave the cohort at any time as they move to centres that are not part of the collaboration.…”

Section: Discussionmentioning

confidence: 99%

Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study

Sabin

Hill

Lampe

et al. 2005

BMJ

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Ten-year trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic

Cited by 41 publications

References 15 publications

Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population

Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population

Delay in Introducing Antiretroviral Therapy in Patients Infected by Hiv in Brazil, 2003-2006

Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study

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