Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala

Meléndez, Johanna; Reinhardt, Samuel W.; O’Halloran, Jane A.; Spec, Andrej; Cordon, Andrea Alonzo; Powderly, William G.; Villatoro, Carlos Mejia

doi:10.1007/s10461-018-2331-y

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…Thus, limited information and structural disadvantages could explain the late diagnosis. We also found that heterosexual patients were more likely to be associated with AHD at the moment of diagnosis compared with MSM, similar to results found in other studies [ 16 , 17 ]. This is possibly due to awareness campaigns and active HIV screening programs implemented in recent years that have promoted an earlier diagnosis in MSM.…”

Section: Discussionsupporting

confidence: 91%

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Medina

Alastruey‐Izquierdo

Bonilla

et al. 2021

JoF

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Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.

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Section: Discussionsupporting

confidence: 91%

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Medina

Alastruey‐Izquierdo

Bonilla

et al. 2021

JoF

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“…One strategy to encourage the early diagnosis of STIs is to promote testing outside the health setting 109 , 110 . Brazil again stands out for encouraging this practice in official and independent campaigns that aim not only to diagnosis but also to provide information regarding and encourage condom use 111 , 112 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Pereira

França

Costa

et al. 2021

Sci Rep

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To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.

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“…Deaths that occurred within 90 days of patient screening were attributed to the opportunistic infection diagnosed at the DLH. (Meléndez et al, 2019;Medina et al, 2021). As expected, the number of opportunistic infection screening samples received at the DLH from the healthcare facilities located outside of Guatemala City decreased more than the samples obtained from CFLAG, which is located in Guatemala City (43.7% vs 31.2%).…”

Section: Study Design and Data Sourcesmentioning

confidence: 99%

Impact of the COVID-19 pandemic on HIV care in Guatemala

Medina

Alastruey‐Izquierdo

Bonilla

et al. 2021

International Journal of Infectious Diseases

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To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of human immunodeficiency virus (HIV) and deaths from opportunistic infections in Guatemala. Methods: A retrospective study was conducted to investigate the impact of the COVID-19 pandemic on people with HIV at a referral clinic, as well as the disruption of services at a diagnostic laboratory hub (DLH) which provides diagnosis for opportunistic infections to a network of 13 HIV healthcare facilities. Comparative analysis was undertaken using the months March-August from two different time periods: (i) pre- COVID-19 (2017COVID-19 ( -2019; and (ii) during the COVID-19 period (2020). Results: During the COVID-19 period, 7360 HIV tests were performed at Clinica Familiar Luis Angel García, compared with an average of 16,218 tests in the pre-COVID-19 period; a reduction of 54.7% [95% confidence interval (CI) 53.8-55.4%]. Deaths from opportunistic infections at 90 days were 10.7% higher in 2020 compared with 2019 (27.3% vs 16.6%; P = 0.05). Clinical samples sent to the DLH for diagnosis of opportunistic infections decreased by 43.7% in 2020 (95% CI 41.0-46.2%). Conclusion:The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV have been severely affected and deaths from opportunistic infections have increased. The lessons learnt must guide the introduction of strategies to reduce the impact of the pandemic.

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Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala

Cited by 12 publications

References 23 publications

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala

Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Impact of the COVID-19 pandemic on HIV care in Guatemala

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