Korean Patients Presenting with Advanced Human Immunodeficiency Virus Disease: Epidemiological Features by Age Group

We explored factors influencing presentation with advanced human immunodeficiency virus (HIV) disease by age group. Data were derived from a city-wide cross-sectional survey of 759 HIV-infected adults living in Seoul, Korea. The significance of each observed factor was assessed via multivariate logistic regression. 

Of subjects aged 20-34 years, lower educational level had a positive influence on presentation with advanced HIV disease; those recently diagnosed with HIV were more likely to be presented with advanced HIV disease. Of the subjects aged 35-49 years, those w ith advanced HIV disease were more likely to have been diagnosed during health check-ups or via clinical manifestations. Of the subjects aged ≥ 50 years, presentation with advanced HIV disease was significantly more common in older subjects and less common among individuals diagnosed with HIV in 2000-2006. 

In conclusion, a lower educational level in younger subjects and more advanced age in older subjects positively influence the presentation of advanced HIV disease.

Full article at:   http://goo.gl/wa5zKL

By:  Cho Ryok Kang,1,7 Ji Hwan Bang,1,2 Sung-Il Cho,1,3 Kui Nam Kim,4 Hee-jin Lee,4 Bo Yeong Ryu,1,7 Soo Kyung Cho,1,7 Young Hwa Lee,1,3 Myoung-don Oh,1,5 and Jong-Koo Lee1,6

¹Seoul Center for Infectious Disease Control, Seoul, Korea.

²Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

³Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea.

⁴Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea.

⁵Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁶Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁷Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author.

Address for Correspondence: Ji Hwan Bang, MD. Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center 20 Boramaero 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-3209, Fax: +82.2-831-2826, Email:moc.liamg@hcribdnuor

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Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia

Background

Early HIV diagnosis and enrolment in care is needed to achieve early antiretroviral treatment (ART) initiation. Studies on HIV disease stage at enrolment in care from Asian countries are limited. We evaluated trends in and factors associated with late HIV disease presentation over a ten-year period in the largest ART center in Cambodia.

Methods

We conducted a retrospective analysis of program data including all ARV-naïve adults (> 18 years old) enrolling into HIV care from March 2003-December 2013 in a non-governmental hospital in Phnom Penh, Cambodia. We calculated the proportion presenting with advanced stage HIV disease (WHO clinical stage IV or CD4 cell count <100 cells/μL) and the probability of ART initiation by six months after enrolment. Factors associated with late presentation were determined using multivariate logistic regression.

Results

From 2003–2013, a total of 5642 HIV-infected patients enrolled in HIV care. The proportion of late presenters decreased from 67% in 2003 to 44% in 2009 and 41% in 2013; a temporary increase to 52% occurred in 2011 coinciding with logistical/budgetary constraints at the national program level. Median CD4 counts increased from 32 cells/μL (IQR 11–127) in 2003 to 239 cells/μL (IQR 63–291) in 2013. Older age and male sex were associated with late presentation across the ten-year period. The probability of ART initiation by six months after enrolment increased from 22.6% in 2003–2006 to 79.9% in 2011–2013.

Conclusion

Although a gradual improvement was observed over time, a large proportion of patients still enroll late, particularly older or male patients. Interventions to achieve early HIV testing and efficient linkage to care are warranted.

Below:  Evolution in the proportion of individuals enrolling with advanced HIV disease (CD4 cell count < 100 cells/μL or WHO clinical stage IV), Phnom Penh, Cambodia (2003–2013)

Below:  Evolution in the proportion of individuals enrolling with WHO clinical stage IV, Phnom Penh, Cambodia (2003–2013)

Below:  Evolution in the median CD4 count at enrolment into HIV care, Phnom Penh, Cambodia (2003–2013)

Purchase full article at:  http://goo.gl/dWcXMb

By:  

Reaksmey Pe, Bopha Chim, Sopheak Thai, Johan van Griensven

Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia

Lutgarde Lynen, Johan van Griensven

Institute of Tropical Medicine, Antwerp, Belgium

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Gender Difference in Advanced HIV Disease & Late Presentation According to European Consensus Definitions

Effectiveness of highly active antiretroviral therapy is limited for a large proportion of individuals living with HIV presenting for medical care at an advanced stage. Controversial results of gender differences in risk of late HIV diagnosis were reported among existing literatures. Therefore, we conducted this meta-analysis to synthesize a summary of gender differences in risk of advanced HIV disease (AHD) and late presentation (LP) according to European consensus definitions. 

Totally, 32 studies were included based on predetermined selection criteria. The pooled adjusted odds ratios of males presenting with AHD and LP compared with females were 1.73 (95% confidence interval [CI], 1.59-1.89) and 1.38 (95% CI, 1.18-1.62) with significant heterogeneity observed (I(2) = 78.50%, and I(2) = 85.60%, respectively). 

Subgroup analysis revealed that time lag, study location, number of patients, proportion of females, study design, number of adjusted variables might be potential source of heterogeneity. Sensitivity analysis showed robustness of the results. No publication bias was observed in studies on AHD or LP. 

The current meta-analysis indicated that males are at higher risk of AHD or LP compared with females. More attention should be paid to males to make sure early testing, diagnosis, and treatment, and ultimately improve individual and population health.

Via: http://goo.gl/iWFoJ6  Full article at:  http://goo.gl/aSZ8rW

By: Jiang H1, Yin J1, Fan Y1, Liu J1, Zhang Z1, Liu L1, Nie S1.

• 1Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China. 

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