Delayed HIV diagnosis and initiation of antiretroviral therapy

Lodi, Sara; Dray‐Spira, Rosemary; Touloumi, Giota; Braun, Dominique L; Teira, Ramón; Monforte, Antonella d’Arminio; Gallois, Anne; Zangerle, Robert; Spire, Bruno; Dabis, François; Stähelin, Cornelia Johanna; Termote, Monique; Kirk, Ole; Chêne, Geneviève; Egger, Matthias; Amo, Julia del

doi:10.1097/qad.0000000000000410

Cited by 41 publications

(19 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This explanation is emphasized by our results about the reason for HIV testing, showing that patients diagnosed by clinical suspicion were 5 times more likely to be . This observation could be explained by the fact that outreach campaigns, were more understandable for those who were enrolled in school and they were therefore screened earlier [27]. Location was not associated to late presentation in our study.…”

Section: Factors Associated With Late Presentationcontrasting

confidence: 35%

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

Zannou¹,

Gandaho²,

Azon-Kouanou³

et al. 2017

OJIM

View full text Add to dashboard Cite

show abstract

Section: Factors Associated With Late Presentationcontrasting

confidence: 35%

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

Zannou¹,

Gandaho²,

Azon-Kouanou³

et al. 2017

OJIM

View full text Add to dashboard Cite

show abstract

“…People presenting late often declare that they were not ill, although the majority of them were symptomatic during the year preceding HIV diagnosis and consulted a physician for these symptoms [32]. In other cases (as among foreign patients, women and IDUs), socioeconomic status and poor access to health care may have contributed to late presentation [37, 38]. At the same time, it is possible that some other factors may contribute to decreased use of condoms, either among heterosexuals or MSM, as alcohol abuse and/or illicit drug use.…”

Section: Discussionmentioning

confidence: 99%

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

et al. 2016

View full text Add to dashboard Cite

BackgroundWe aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.MethodsAll antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.Results19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004–2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.ConclusionScreening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3477-z) contains supplementary material, which is available to authorized users.

show abstract

“…In spite of the critical role of ART, there are widespread inequalities in accessing and utilizing this service [11–14]. International research suggests that lower socioeconomic status (SES) was closely related to delayed ART initiation, lower treatment adherence, and poorer outcomes [11–14].…”

Section: Introductionmentioning

confidence: 99%

“…International research suggests that lower socioeconomic status (SES) was closely related to delayed ART initiation, lower treatment adherence, and poorer outcomes [11–14]. For example, previous studies showed the positive association between education and early HIV diagnosis and ART initiation [11,15,16]. Furthermore, WHO emphasized in “Treatment 2.0” guideline that wealthier PLWH were more likely to have access to better HIV/AIDS care services [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of Socioeconomic Inequality on Access, Adherence, and Outcomes of Antiretroviral Treatment Services for People Living with HIV/AIDS in Vietnam

et al. 2016

View full text Add to dashboard Cite

BackgroundEnsuring an equal benefit across different patient groups is necessary while scaling up free-of-charge antiretroviral treatment (ART) services. This study aimed to measure the disparity in access, adherence, and outcomes of ART in Vietnam and the effects of socioeconomic status (SES) characteristics on the levels of inequality.MethodsA cross-sectional study was conducted in 1133 PLWH in Vietnam. ART access, adherence, and treatment outcomes were self-reported using a structured questionnaire. Wealth-related inequality was calculated using a concentration index, and a decomposition analysis was used to determine the contribution of each SES variable to inequality in access, adherence, and outcomes of ART.ResultsBased on SES, minor inequality was found in ART access and adherence while there was considerable inequality in ART outcomes. Poor people were more likely to start treatment early, while rich people had better adherence and overall treatment outcomes. Decomposition revealed that occupation and education played important roles in inequality in ART access, adherence, and treatment outcomesConclusionThe findings suggested that health services should be integrated into the ART regimen. Furthermore, occupational orientation and training courses should be provided to reduce inequality in ART access, adherence, and treatment outcomes.

show abstract

Delayed HIV diagnosis and initiation of antiretroviral therapy

Abstract: Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation.

Cited by 41 publications

References 32 publications

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

Impact of Socioeconomic Inequality on Access, Adherence, and Outcomes of Antiretroviral Treatment Services for People Living with HIV/AIDS in Vietnam

Contact Info

Product

Resources

About