Prevalence of and factors associated with advanced HIV disease among newly diagnosed people living with HIV in Guangdong Province, China

Abstract

Introduction: A high proportion of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), which is detrimental to "90-90-90" targets to end AIDS by 2030. This study aimed to explore the prevalence of and factors related to AHD among newly diagnosed PLHIV in Guangdong Province, China. Methods: Newly diagnosed PLHIV were recruited from six cities in Guangdong Province from May 2018 to June 2019. AHD was defined as an initial CD4 count <200 cells/µL or an AIDS-defining event within one month of HIV diagnosis. Data from a questionnaire and the national HIV surveillance system were used to explore the potential factors related AHD. Results: A total of 400 of 997 newly diagnosed PLHIV were defined as having AHD with a proportion of 40.1%. After adjusting for statistically significant variables in univariate analysis, multivariable logistic regressions showed that individuals aged 30 to 39 years (adjusted odds ratio (aOR) = 1.77, 95% confidence interval (CI): 1.13 to 2.79) and ≥50 years (aOR = 1.98, 95% CI: 1.15 to 3.43) were at a higher risk of AHD than those aged 18 to 29 years. Participants diagnosed by voluntary counselling and testing (VCT) clinics were less likely to have AHD (aOR = 0.67, 95% CI: 0.48 to 0.94) than those diagnosed at medical facilities. Participants who had ever considered HIV testing (aOR = 0.66, 95% CI: 0.45 to 0.98) and who had high social support (aOR = 0.73, 95% CI: 0.55 to 0.97) were at a lower risk of AHD, whereas participants who had HIV-related symptoms within one year before diagnosis were at a higher risk of AHD (aOR = 2.09, 95% CI: 1.58 to 2.77). The most frequent reason for active HIV testing was "feeling sick" (42.4%, 255/601), and the main reason for never considering HIV testing was "never thinking of getting HIV" (74.0%, 542/732). Conclusions: Low-risk perception and a lack of awareness of HIV-related symptoms resulted in a high proportion of AHD in Guangdong Province, especially among the elderly, those diagnosed at medical facilities and those with low social support. Strengthening AIDS education and training programmes to scale up HIV testing through provider-initiated testing and counselling in medical facilities and VCT could facilitate early HIV diagnosis.

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

“…Our ndings are consistent with previous studies showing that older age and ART regimen (AZT/3TC/NVP and AZT/3TC/LPV/r or ABC) are risk factors for presenting AHD (12,35,36), and also with reports showing that older age and being on WHO Clinical Stage IV were risk factors for "less than expected improvement in CD4 cell counts" (29,47). Assessment of these factors may help to identify HIV-infected pregnant women with AHD and thus, prioritize case management and prevention of disease progression.…”

“…Logistic regression was performed to evaluate AHD temporal distribution per year and the factors associated with the two main outcomes: AHD at the rst ANC visit and "less than expected improvement in the CD4 + cell count" in the postpartum visit. The adjustment covariates included in logistic regression analysis were those previously described in the literature (29,30,35,36), i.e., age group, gestational age, time on ART, ART regimen, body mass index and gravidity for AHD at the rst ANC visit, and age group, gestational age, time on ART, WHO clinical stage and AHD for "less than expected improvement in the CD4 cell count" in the postpartum visit.…”

Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study

“…Diminished immune function and recovery and higher comorbidity may contribute to an increased risk of death among older PLHIV (16). The relationship between male sex and mortality could be explained by the higher odds of late presentation for care, AHD, and late ART among men (15,17). Notably, approximately four in five PLHIV were men in this study, which was in line with previous studies (8,18), highlighting the urgent need to promote early diagnosis and treatment among them.…”

“…As an indispensable part of the HIV care continuum, VCT is flattening the HIV-related knowledge gap when high-risk people come to clinics, reducing the possible late testing and late ART. However, it is hard to touch some subpopulations in genuine need through regular VCT purveyed at healthcare centers or the Centers for Disease Control and Prevention (CDC) (17). We could do further establish mobile VCT at the transport interchange for internal migrant workers to access HIV testing.…”

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

“…is study estimated that the prevalence of AHD in patients from Southern Iran is 53.9%, suggesting the diagnosis and treatment of HIV as a serious problem in Iran. e 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].…”