Late presentation of HIV infection in the country of Georgia: 2012-2015

Abstract

Late presentation for HIV care has important individual and population implications. The objective of this study was to explore the problem of late presentation in the country of Georgia. Data on adult persons newly diagnosed with HIV in Georgia between 2012 and 2015 were extracted from the national AIDS Health Information System. Late presenter was defined as a person diagnosed with HIV with a CD4 cell count <350 cells/mm3 or an AIDS defining illness regardless of the CD4 cell count in the six months after HIV diagnosis. Late presenter with advanced disease was defined as a person diagnosed with HIV with a CD4 cell count <200 cells/mm3 or an AIDS defining illness, regardless of CD4 cell count in the six months after HIV diagnosis. Among 2267 adults diagnosed with HIV in Georgia in 2012–2015, 1987 (87.6%) had CD4 cell count measured within 6 months of HIV diagnosis and were included in the analysis. Among them 1260 (63.4%) patients were classified as late presenters and 870 (43.8%) as late presenters with advanced disease. The proportion of late presenters declined from 71.1% in 2012 to 55.5% in 2015 (p<0.0001), while presentation late with advanced disease decreased from 56.6% in 2012 to 34.5% in 2015 (p<0.0001). Late presentation was most common among people who inject drugs (77.7%). Overall 186 patients died over the studied period. Mortality was higher both among late presenters (6.74 per 100 person-years vs. 1.08 per 100 person-years, p<0.0001) and late presenters with advanced disease (8.93 per 100 person-years vs. 1.34 per 100 person-years, p<0.0001). High prevalence of late presentation in Georgia reflects insufficiency in HIV testing services. Better testing strategies are needed to improve earlier diagnosis and disease outcomes.

Long‐term trends in HIV care entry: over 15 years of clinical experience from Poland

“…Also, in the latest ECDC study from 2017 across the WHO EU Region, the proportion of individuals diagnosed late increased with age . In our study, increased risks of late entry and advanced disease were observed for PWID, in line with data reported for other European cohorts .…”

“…Other European studies also noted high proportions of subjects presenting late . Similar trends of late entry to care were reported in the large Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study for the period of 2001–2010, which does not include Polish data.…”

High Yield of Active Tuberculosis Case Finding Among HIV-Infected Patients Using Xpert MTB/RIF Testing

“…Specifically, in the country of Georgia, TB remains the leading cause of death in PLWH [8]. A combination of factors, including increasing HIV prevalence and drug-resistant TB, high rates of late HIV diagnosis, and overlapping risk factors for TB and HIV, makes Georgia particularly vulnerable to a TB/HIV epidemic [6, 9, 10]. In order to alleviate both morbidity and mortality associated with TB in PLWH, active case finding (ACF) for TB has been recommended as a strategy for regions with high TB and HIV incidence [7, 11–13].…”

A Simple Symptom Score for Acute Human Immunodeficiency Virus Infection in a San Diego Community-Based Screening Program

“…AHI is associated with transient levels of high-titer viremia [1,3], which is a driver of HIV transmission among men who have sex with men (MSM) in the United States. Diagnosis of AHI has been associated with a reduction in risk behavior [4] and could prevent later presentation and treatment initiation, which is associated with worse outcomes [5][6][7]. Additionally, treatment initiation during AHI preserves immune function [8] and limits HIV reservoirs compared to later treatment [9].…”