Abstract
BackgroundTimely access to antiretroviral therapy is a key to controlling HIV infection. Late diagnosis and presentation to care diminish the benefits of antiretrovirals and increase risk of transmission. We aimed to identify late presenters in patients sent for first CD4 T cell count after HIV diagnosis, for therapy initiation evaluation. Further we aimed at identifying patient factors associated with higher risk of late presentation.MethodsRetrospective data collection and analysis was done for 3680 subjects visiting the laboratory for CD4 T cell counts between 2001 and 2007. We segregated the patients on basis of their CD4 T cell counts after first HIV diagnosis. Factors associated with risk of late presentation to CD4 T cell counts after HIV diagnosis were identified using univariate analysis, and the strength of association of individual factor was assessed by calculation of odds ratios.ResultsOf 3680 subjects, 2936 (83.37%) were defined as late presenters. Late testing varied among age groups, transmission categories, and gender. Males were twice as likely to present late as compared to females. We found significant positive association of heterosexual transmission route (p < 0.001), and older age groups of 45 years and above (p = 0.0004) to late presentation. Female sex, children below 14 years of age and sexual contact with HIV positive spouse were associated with significantly lower risks to presenting late. Intravenous drug users were also associated with lower risks of late presentation, in comparison to heterosexual transmission route.ConclusionsThe study identifies HIV infected population groups at a higher risk of late presentation to care and treatment. The risk factors identified to be associated with late presentation should be utilised in formulating targeted public health interventions in order to improve early HIV diagnosis.
Highlights
Access to antiretroviral therapy is a key to controlling HIV infection
During 2001-2007, a total of 4,260 patients were tested 2006 for CD4 T cell counts at the laboratory
3,680 subjects coming for HAART initiation evaluation 2007 were retrospectively included in the study, excluding subjects coming for follow-up visit or subjects already on Sex antiretroviral therapy at the time of first visit to laboratory
Summary
Access to antiretroviral therapy is a key to controlling HIV infection. Late diagnosis and presentation to care diminish the benefits of antiretrovirals and increase risk of transmission. During the natural course of HIV infection, there is a progressive loss of CD4 T cells; the rate of this loss being variable in patients, but averaging around 60-100 cells/uL per year [1,2,3]. This drop in CD4 T cells leads to a severely immunocompromised state in the infected host. Thereupon, a reduction in CD4 T cells to below 200 cells/uL makes the host highly susceptible to opportunistic infections and increases overall AIDS related morbidity and mortality.
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