Time trends and correlates of late presentation for HIV care in Northern Greece during the decade 2000 to 2010

Abstract

BackgroundThe aim of our study was to assess the extent of late presentation for HIV care in Northern Greece during the period 2000 to 2010 and to explore correlations aiming to provide guidance for future interventions.MethodsHIV-positive patients with no prior history of HIV care at presentation and with a CD4 T cell count within three months from the first confirmatory Western blot result were eligible for this study. Late presentation and advanced HIV disease were defined in concordance with the recommendations of the European Late Presenter Consensus working group. Time trends in presentation status and risk factors linked to late presentation and advanced HIV disease were identified in multivariable logistic regression models. Additional analyses after multiple imputation of missing values were performed to assess the robustness of our findings.ResultsThe status at presentation was evaluated for 631 eligible HIV-positive individuals. Overall, 52.5% (95% CI: 48.6% to 56.4%) of patients presented late for HIV care and 31.2% (95% CI: 27.6% to 34.8%) presented with advanced HIV disease. Time trends were consistent with an improvement in the presentation status of our study population (p<0.001). Risk factors associated with late presentation in multivariable logistic regression were intravenous drug use, heterosexual HIV transmission, immigrant status and age at diagnosis.ConclusionsDespite the trend for improvement, a significant proportion of newly diagnosed HIV-positive patients present late for care. Targeted interventions with focus on social groups such as the elderly, persons who inject drugs, immigrants and individuals at risk for heterosexual HIV transmission are mandated.

What's pregnancy got to do with it? Late presentation to HIV/AIDS services in Northeastern Brazil

“…This is consistent with the findings from other studies (Adler, Mounier-Jack, & Coker, 2009; Helleberg et al, 2012; Metallidis et al, 2012; Tey et al, 2012; Vincent et al, 2012; Vives et al, 2012). Studies suggest that the progression of infection may be more rapid in older individuals (Kirk & Goetz, 2009; Manfredi, 2002, 2004).…”

“…Despite increasing availability of antiretroviral therapy (ART) in many countries, studies have documented that HIV-positive individuals continue to access HIV/AIDS services at an advanced stage of infection (Althoff et al, 2010; Metallidis et al, 2012; O’Shea, Ebrahim, Egli, Redmond, & McConkey, 2013; Oliva et al, 2010; Wohlgemut, Lawes, & Laing, 2012). This late presentation (LP) to HIV/AIDS services is a substantial concern given the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission.…”

Drug use as a driver of HIV risks

“…The use of these compounds is increasing in many countries including Eastern Europe and Central Asia, both of which have seen the arrival of heroin synthetic substitutes and home made drugs such as krokodil (51, 52). Krokodil use has increased in Russia, Kazakhstan and Ukraine due to changes in heroin availability, purity, and price, all of which are associated with heroin ‘droughts,’ police interdiction, legislative changes targeting poppy imports, and rising poverty levels in Russia since the 2008 global economic downturn (53).…”

High rates of transmitted drug resistance among newly-diagnosed antiretroviral naïve HIV patients in Northern Greece, data from 2009–2011

“…Europe-wide surveillance data estimated the prevalence of transmission of drug-resistant human immunodeficiency virus type 1 (HIV-1) in Europe to be stabilizing at levels as high as 8.4% (95% CI 7.4-9.5%) for the period 2002-06 [1]. Studies reporting on more recent nationwide data provided comparable estimates for transmitted drug resistance (TDR) across Europe ranging from 5.6% to 12.4% [2][3][4][5][6].…”