Temporal Trends in Age at HIV Diagnosis in Cohorts in the United States, the Caribbean, and Central and South America

Crabtree-Ramírez, Brenda; Vega, Yanink Neried Caro; Shepherd, Bryan E.; Turner, Megan; Carriquiry, Gabriela; Fink, Valeria; Luz, Paula M.; Cortés, Claudia; Rouzier, Vanessa; Padgett, Denis; Jayathilake, Karu; McGowan, Catherine C.; Person, Anna K.

doi:10.1007/s10461-014-0974-x

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…A recent study in Mexico City found that the proportion of individuals entering care who were diagnosed with HIV before the age of 25 significantly decreased from 1995–2012, highlighting that even if younger individuals are diagnosed early they may be delaying their entry into care. [ 37 ] Results from our study are consistent with this observation, with older individuals entering care with very low CD4 cell counts. Although we were unable to assess whether late entry into care was due to delayed testing or delayed presentation to care, our findings highlight the importance of promoting testing among older individuals who may be considered lower risk by providers, and who may not perceive the extent of their risk for HIV.…”

Section: Discussionsupporting

confidence: 89%

CD4 Counts at Entry to HIV Care in Mexico for Patients under the “Universal Antiretroviral Treatment Program for the Uninsured Population,” 2007–2014

Hernández-Romieu¹,

Rı́o²,

Hernández-Ávila³

et al. 2016

PLoS ONE

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In Mexico, public health services have provided universal access to antiretroviral therapy (ART) since 2004. For individuals receiving HIV care in public healthcare facilities, the data are limited regarding CD4 T-lymphocyte counts (CD4e) at the time of entry into care. Relevant population-based estimates of CD4e are needed to inform strategies to maximize the impact of Mexico’s national ART program, and may be applicable to other countries implementing universal HIV treatment programs. For this study, we retrospectively analyzed the CD4e of persons living with HIV and receiving care at state public health facilities from 2007 to 2014, comparing CD4e by demographic characteristics and the marginalization index of the state where treatment was provided, and assessing trends in CD4e over time. Our sample included 66,947 individuals who entered into HIV care between 2007 and 2014, of whom 79% were male. During the study period, the male-to-female ratio increased from 3.0 to 4.3, reflecting the country's HIV epidemic; the median age at entry decreased from 34 years to 32 years. Overall, 48.6% of individuals entered care with a CD4≤200 cells/μl, ranging from 42.2% in states with a very low marginalization index to 52.8% in states with a high marginalization index, and from 38.9% among individuals aged 18–29 to 56.5% among those older than 50. The adjusted geometric mean (95% confidence interval) CD4e increased among males from 135 (131,142) cells/μl in 2007 to 148 (143,155) cells/μl in 2014 (p-value<0.0001); no change was observed among women, with a geometric mean of 178 (171,186) and 171 (165,183) in 2007 and 2014, respectively. There have been important gains in access to HIV care and treatment; however, late entry into care remains an important barrier in achieving optimal outcomes of ART in Mexico. The geographic, socioeconomic, and demographic differences observed reflect important inequities in timely access to HIV prevention, care, and treatment services, and highlight the need to develop contextual and culturally appropriate prevention and HIV testing strategies and linkage programs.

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Section: Discussionsupporting

confidence: 89%

CD4 Counts at Entry to HIV Care in Mexico for Patients under the “Universal Antiretroviral Treatment Program for the Uninsured Population,” 2007–2014

Hernández-Romieu¹,

Rı́o²,

Hernández-Ávila³

et al. 2016

PLoS ONE

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“…The trend towards younger age at diagnosis in both heterosexuals and MSM are also observed in the United States [ 36 , 37 ]. Similarly, the median age at HIV diagnosis among MSM also declined from 38.8 years in 2007 to 35.9 years in 2009 in Victoria, Australia.…”

Section: Discussionmentioning

confidence: 92%

HIV epidemics in Shenzhen and Chongqing, China

et al. 2018

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ObjectiveMen who have sex with men (MSM) and heterosexuals are the populations with the fastest growing HIV infection rates in China. We characterize the epidemic growth and age patterns between these two routes from 2004 to 2015 in Chongqing and Shenzhen, China.Design and methodsData were downloaded from the National HIV/ AIDS Comprehensive Response Information Management System. For the new HIV diagnoses of heterosexuals and MSM in both cities, we estimated the growth rates by fitting different sub-exponential models. Heat maps are used to show their age patterns. We used histograms to compare these patterns by birth cohort.ResultsThe MSM epidemics grew significantly in both cities. Chongqing experienced quadratic growth in HIV reported cases with an estimated growth rate of 0.086 per week and a “deceleration rate” of 0.673. HIV reported cases of MSM in Shenzhen grew even more drastically with a growth rate of 0.033 per week and “deceleration rate” of 0.794. The new infections are mainly affecting the ages of 18 to 30 in Chongqing and ages of 20 to 35 in Shenzhen. They peaked in early 1990’s and mid-1990’s birth cohorts in Chongqing and Shenzhen respectively. The HIV epidemic among heterosexuals grew rapidly in both cities. The growth rates were estimated as 0.02 and 0.028 in Chongqing and Shenzhen respectively whereas the “deceleration rates” were 0.878 and 0.790 in these two places. It affected mostly aged 18 to 75 in males and 18 to 65 in females in Chongqing and aged 18 to 45 in males and 18 to 50 in females in Shenzhen in 2015. In Chongqing, the heterosexual female epidemics display two peaks in HIV diagnoses in the birth cohorts of early 1950’s and early 1980’s, with heterosexual male epidemics peaked in early 1940’s and early 1960’s. The heterosexual male and female epidemics display higher rates in the birth cohort 1940-1960, than the birth cohort 1960-1990. It peaked in birth cohorts of 1950’s and 1980’s in Shenzhen.ConclusionsWe revealed striking differences in epidemic growth and age patterns of the HIV epidemics in these two cities. Our results may be used to inform age-targeted public health policies to curb their epidemic growth.

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“…Expanding the utility of clinical databases to include social determinants and to link maternal and pediatric databases are goals of our CCASAnet network, as well as improving the quality and completeness of data collection. 36–37 …”

Section: Discussionmentioning

confidence: 99%

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

Luque¹,

Jenkins

Shepherd

et al. 2017

The Journal of Pediatrics

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Objectives To assess the risks of and factors associated with mortality, loss to followup, and changing regimens after perinatally HIV-infected children initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean. Study design This 1997–2013 retrospective cohort study included 1174 ART-naïve perinatally-infected children who started cART age<18 years (median 4.7 years; interquartile range [IQR] 1.7–8.8) at one of six cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet). Median follow-up was 5.6 years (interquartile range [IQR] 2.3 to 9.3). Study outcomes were all-cause mortality, loss to followup, and major changes/interruption/stopping of cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. Results Only 52% started cART <5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR: 201–902); median CD4% was 16% (IQR:10–23). Probability of death was high in the first year of cART: 0.06 (95% confidence interval [CI] 0.04–0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (CI 0.10–0.14). Cumulative incidences for loss to followup and regimen change after five years were 0.16 (CI 0.14–0.18) and 0.30 (CI 0.26–0.34), respectively. Younger children had the highest risk of mortality, whereas older children had the highest risk of being lost to followup or changing regimens. Conclusions Innovative clinical and community approaches are needed for quality improvement for HIV pediatric care in the Americas.

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Temporal Trends in Age at HIV Diagnosis in Cohorts in the United States, the Caribbean, and Central and South America

Cited by 3 publications

References 17 publications

CD4 Counts at Entry to HIV Care in Mexico for Patients under the “Universal Antiretroviral Treatment Program for the Uninsured Population,” 2007–2014

CD4 Counts at Entry to HIV Care in Mexico for Patients under the “Universal Antiretroviral Treatment Program for the Uninsured Population,” 2007–2014

HIV epidemics in Shenzhen and Chongqing, China

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

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