Identifying risk factors for late HIV diagnosis and survival analysis of people living with HIV/AIDS in Iran (1987–2016)

Abstract

Background Late-diagnosis of HIV is a major challenge for the control and prevention of AIDS in the world. The present study aimed to specify factors associated with the late diagnosis of HIV in Iran from 1987 to 2016. Methods In this retrospective cohort study, data for 4402 diagnosed HIV/AIDS patients were extracted from 158 behavioral disease counseling centers of 31 Iranian provinces. We defined late diagnosis as having a CD4 count less than 350 within 3 months after diagnosis. Multiple logistic regression analysis was used to determine the factors influencing late diagnosis. Moreover, we used multivariate Cox regression to assess the association of these factors with the patients’ survival. Results In this study, the prevalence of late diagnosis among the patients was 58.2%. People aged 50 years and over (adjusted OR = 3.55), transmission through blood transfusion (adjusted OR = 2.89), co-infection with tuberculosis (adjusted OR = 2.06), and male gender (adjusted OR = 1.38) were the strongest predictors for late diagnosis of HIV. On the other hand, baseline CD4 (adjusted HR = 2.21), people aged 50 and over (adjusted HR = 1.81), male gender (adjusted HR = 1.76), being a widow (adjusted HR = 1.68), people with unknown transmission way (adjusted HR = 18.24), people who inject drugs (adjusted HR = 1.87), diagnosis at previous years (adjusted HR = 2.45) and co-infection with tuberculosis (adjusted OR = 1.77) significantly associated with the survival of patients. Conclusion The prevalence of late diagnosis is high among Iranian HIV/AIDS. The risk factors of late diagnoses include being males and aged 50 years and over, transmission through blood transfusion, and co-infection with tuberculosis. Therefore, implementation of screening programs for early diagnosis of HIV these high risk groups is recommended to Iranian health providers and policymakers.

Factors Associated with Baseline CD4 Cell Counts and Advanced HIV Disease among Male and Female HIV-Positive Patients in Iran: A Retrospective Cohort Study

“…The prevalence is higher than the reported figure from China (40.1%) and lower than in Senegal (71%) [ 11 , 20 ]. Diagnosis of HIV in Iran has clearly less quality than the goals defined by UNAIDS, which leads to the loss of opportunities for early diagnosis and treatment, and therefore diagnosing patients in the advanced stage with a poor prognosis [ 21 ].…”

Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study

“…Iran has the largest concentrated HIV epidemic among the Middle East countries (12). According to the latest report (2020) from UNAIDS, about 54,000 Iranians are living with HIV and 3,200 PLHIV are dying of AIDS-related illnesses annually.…”

“…According to this report, the most common way of HIV transmission in Iran is drug injection, and most cases occur in men of 15-44 years of age. Also, only 42% of PLHIV in Iran are aware of their disease status, and only 29% receive ART (12,13). Despite the importance of HIV and its timely treatment initiation, we found no published information on the rate of late ART initiation among PLHIV in Iran.…”

Real-world data in late presentation of HIV infection in Suzhou, China: Results from four consecutive cross-sectional surveys, 2017–2020

“…In our study, high percentages of late presentation were shown over the time, with more than half each year. It is higher than that in some countries of Europe ( 14 , 19 – 22 ), Australia ( 17 ), and the United States ( 23 ), lower than that in Panama ( 18 ), South Africa ( 24 , 25 ), Ethiopia ( 26 ), and Guangxi of China ( 12 ), and similar to that in Iran ( 27 ). It is important to notice that higher percentages of late presentation were indicated among people over 40 years old, retirees, farmers, married, heterosexuals, and people registered in Suzhou in our study.…”