Abstract
BackgroundOur objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages.MethodsWe collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing.ResultsOf the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003.ConclusionA considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups.
Highlights
Our objective was to determine the frequency and determinants of presentation to care with advanced human immunodeficiency virus (HIV) disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages
Several recent studies have evaluated the factors associated with presentation to care with advanced HIV disease [1,2,3,4,5,6,7], few studies have assessed the factors associated with presentation to care at this stage, by delay from first positive HIV test to presentation to care
We assessed the potential risk factors associated with “delayed presentation to care"/ "late testing” and presentation to care with advanced HIV disease
Summary
Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Despite the availability and known benefits of combined antiretroviral therapy (cART), a considerable proportion of HIV-infected patients have experienced significant immunodeficiency or disease progression before they present to care [1,2,3,4,5,6,7]. These patients often have poor prognoses [8], because cART reduces HIV RNA and mortality more effectively when it is initiated. The objective of this study was to determine the frequency and characteristics associated with late HIV testing with an advanced HIV disease and earlier HIV testing followed by delayed presentation to care with an advanced HIV disease among HIV-infected patients in Brussels (Belgium) and Northern France
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
