Abstract
BackgroundStarting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI) in this region.MethodologyCross-sectional analysis from 9817 HIV-infected treatment-naïve patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico) from October 1999 to July 2010. LHI had CD4+ count ≤200cells/mm3 prior to HAART. Late testers (LT) were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters (LP) initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed.Principal FindingsAmong subjects starting HAART (n = 9817) who had baseline CD4+ available (n = 8515), 76% were LHI: Argentina (56%[95%CI:52–59]), Chile (80%[95%CI:77–82]), Haiti (76%[95%CI:74–77]), Honduras (91%[95%CI:87–94]), Mexico (79%[95%CI:75–83]), Peru (86%[95%CI:84–88]). The proportion of LHI statistically changed over time (except in Honduras) (p≤0.02; Honduras p = 0.7), with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses (CSA). Older patients were more likely LHI in Argentina and Peru (OR 1.21 per +10-year of age, 95%CI:1.02–1.45; OR 1.20, 95%CI:1.02–1.43; respectively), but not in CSA (OR 1.07, 95%CI:0.94–1.21). Higher education was associated with decreased risk for LHI in Chile (OR 0.92 per +1-year of education, 95%CI:0.87–0.98) (similar trends in Mexico, Peru, and CSA). LHI with date of HIV-diagnosis available, 55% were LT and 45% LP.ConclusionLHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation are needed to maximize benefits from HAART in the region.
Highlights
Since the introduction of highly active antiretroviral therapy (HAART) for the treatment of HIV infection, the benefits in survival have been clearly established [1]
late HAART initiator (LHI) was highly prevalent in CCASAnet sites, mostly due to Late testers (LT); the main risk factors associated were being male and older age
The aims of this study were to evaluate the proportion of patients who were LHI between the years of 2000 and 2010, to assess trends across the study period, to look for risk factors associated with LHI, and to determine if LHI was due to late diagnosis or late presentation using data from the Caribbean, Central and South American network for HIV Research (CCASAnet) [24]
Summary
Since the introduction of highly active antiretroviral therapy (HAART) for the treatment of HIV infection, the benefits in survival have been clearly established [1]. The stage of HIV infection at the time of HAART initiation plays an important role in patients’ prognosis after treatment. Patients with advanced disease when starting HAART are less likely to achieve virological suppression, more likely to modify their therapy due to adverse events, have a higher mortality rate and represent a financial strain in public health services, as compared with those who initiate earlier [2,3,4,5,6,7,8,9,10,11]. Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI) in this region
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