Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning

Opstal, S.E.M. van; Zwan, J. S. van der; Wagener, Marlies; Been, Sabrina; Miedema, Harald S.; Roelofs, Pepijn D D M; Gorp, Eric C. M. Van

doi:10.1007/s10461-018-2082-9

Cited by 17 publications

(14 citation statements)

References 43 publications

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“…Furthermore, according to other studies in Poland and the Netherlands, males were also more prevalent in the late presenters’ population. These results are consistent with our study [ 16 , 17 , 18 ].…”

Section: Discussionsupporting

confidence: 94%

Determinants of HIV-1 Late Presentation in Patients Followed in Europe

et al. 2021

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To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0–41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.

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Section: Discussionsupporting

confidence: 94%

Determinants of HIV-1 Late Presentation in Patients Followed in Europe

et al. 2021

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“…The pattern of LP varied across countries and regions. Reasons for LP are diverse, and include different testing strategies, challenges to identify and effectively reach those requiring a test, missed opportunities to offer a test, low self-perceived risk or limited knowledge about risk factors for HIV infection, fear of the implications of a positive test, perceived stigma and legal and regulatory barriers to testing and treatment [ 14 , 27 , 35 – 39 ]. There is a need for a comprehensive and holistic approach in order to address these known causes for LP.…”

Section: Discussionmentioning

confidence: 99%

Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010–2016

Lacombe¹,

Groups²,

Cohere³

2020

BMC Infect Dis

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Background Late presentation (LP), defined as a CD4 count < 350/mm3 or an AIDS-event at HIV-diagnosis, remains a significant problem across Europe. Linking cohort and surveillance data, we assessed the country-specific burden of LP during 2010–2016 and the occurrence of new AIDS events or deaths within 12 months of HIV-diagnosis believed to be attributable to LP. Methods Country-specific percentages of LP and AIDS-events/death rates (assessed with Poisson regression) observed in The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and EuroSIDA cohorts, were applied to new HIV-diagnoses reported to the European Centre for Disease Prevention and Control. The estimated number of LP in the whole population was then calculated, as was the number of excess AIDS-events/deaths in the first 12 months following HIV-diagnosis assumed to be attributable to LP (difference in estimated events between LP and non-LP). Results Thirty-nine thousand two hundred four persons were included from the COHERE and EuroSIDA cohorts, of whom 18,967 (48.4%; 95% Confidence Interval [CI] 47.9–48.9) were classified as LP, ranging from 36.9% in Estonia (95%CI 25.2–48.7) and Ukraine (95%CI 30.0–43.8) to 64.2% in Poland (95%CI 57.2–71.3). We estimated a total of > 320,000 LP and 12,050 new AIDS-events/deaths attributable to LP during 2010–2016, with the highest estimated numbers of LP and excess AIDS-events/deaths in Eastern Europe. Country-level estimates of excess events ranged from 17 AIDS-events/deaths (95%CI 0–533) in Denmark to 10,357 (95%CI 7768-147,448) in Russia. Conclusions Across countries in Europe, the burden of LP was high, with the highest estimated number of LP and excess AIDS-events/deaths being in Eastern Europe. Effective strategies are needed to reduce LP and the attributable morbidity and mortality that could be potentially avoided.

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“…Indeed, after more than 30 years since the beginning of the epidemic, around 40% of new diagnoses worldwide still occur in subjects with less than 200 CD4+/uL [1,2]. Reasons for late presentation range from perception of not being at risk for HIV infection, access to services, stigma and discrimination and are difficult to be addressed [3]. Concerning antiretroviral treatment, patients presenting with an advanced HIV disease, especially if they are symptomatic or with a diagnosis of one or more opportunistic infections, are usually excluded from randomized clinical trials and only a few studies have investigated antiretroviral regimens in these patients [4–6].…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized trial on abacavir/lamivudine plus darunavir/ritonavir or raltegravir in HIV-positive drug-naïve patients with CD4<200 cells/uL (the PRADAR study)

et al. 2019

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BackgroundVery few data are available on treatment in HIV Late presenter population that still represents a clinical challenge.MethodsProspective, multicenter, randomized open-label, 2 arm, phase-3 trial comparing the 48-week virological response of two different regimens: abacavir/lamivudine + darunavir/r vs abacavir/lamivudine + raltegravir in antiretroviral naive with CD4+ counts < 200/mm3 and a viral load (VL)<500,000 copies/mL. The primary Endpoint was the proportion of patients with undetectable viremia (VL<50 copies/mL) after 48 weeks. The planned sample size for this trial was 350 patients.ResultsIn 3 years, 53 patients were screened and 46 enrolled: 22 randomized to raltegravir and 24 to darunavir/r; 7 patients were excluded, 4 because of a VL >500,000 copies/mL and 3 for HLAB5701 positivity. The snapshot analysis at 48 weeks showed a virologic success of 77.3% in raltegravir and 66.7% in darunavir/r. Time to starting treatment was 34.5 days in raltegravir and 53 days in darunavir/r. At the as treated analysis, the median CD4 counts at 48 weeks was 297 cells/μL in raltegravir and 239 cells/μL in darunavir/r. No difference in total cholesterol, while triglycerides were higher in the darunavir/r arm. No statistical analyses were performed due to the low number of patients enrolled.ConclusionsLate presenter patients are frequent but very difficult to enroll in clinical trials, especially in western countries. These regimens and the conditions of many patients could not allow the test and treat strategy. The rate of virologic success was higher than 65% in both arms with a median CD4 cell count >200/μL at week 48.Trial registrationEUDRACT number: 2011-005973-21

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Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning

Cited by 17 publications

References 43 publications

Determinants of HIV-1 Late Presentation in Patients Followed in Europe

Determinants of HIV-1 Late Presentation in Patients Followed in Europe

Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010–2016

A prospective randomized trial on abacavir/lamivudine plus darunavir/ritonavir or raltegravir in HIV-positive drug-naïve patients with CD4<200 cells/uL (the PRADAR study)

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