IJCRR - 6(14), July, 2014
LATE PRESENTATION AMONG A COHORT OF FEBRILE PEOPLE NEWLY HIV INFECTED DIAGNOSED, DURING 2005-2012, IN ALBANIA
Author: Prendushi-Frasheri Xhensila, Kraja Dhimiter, Shpata Vjollca, Harxhi Arjan , Pilaca Arben, Pipero Pellumb, Shkurti-Leka Klodiana, Dervishi Marjeta, Shkjezi Renata, Como Najada
Aim: Antiretroviral therapy decreased mortality and morbidity in people living with HIV/AIDS especially when initiated early, before advanced immunodeficiency has developed. In daily practice, it‘s particularly challenging when dealing with HIV-positive, late presenters individuals. The aim of our study was to determine, frequency, demographic features and factors associated with late presentation among febrile persons, newly diagnosed as HIV infected, during 2005–2012 period of time, in Albania. Methods: All HIV-positive patients with no prior history of HIV infection, admitted to Infectious Diseases Service, University Hospital Centre ?Mother Teresa? of Tirana, from January 2005 to December 2012, were target of our study. ?Late presenter? was defined based on the definition of ?HIV in Europe Initiative?, 2009. Demographic, epidemiological, clinical characteristics, laboratory findings, and outcome data were collected. Results: In total 87 cases (92.6%) out of 94 patients newly diagnosed with HIV were late presenters. According to univariate analysis, the age, male gender, heterosexual contact, emigration and level of education were associated with late presentation for HIV diagnosis. In the multivariate analysis, age (30-39), male gender, heterosexual contact, migration status and level of education were the only independent risk factors for late presentation. Conclusion: A considerable proportion of people newly diagnosed HIV infected, enter late in health care, presenting advanced HIV disease and consequently are treated rather late. In order to be able to detect and treat them early as recommended by international guidelines, it‘s necessary to develop policies and interventions targeting social categories at high risk for late presentation.
Keywords: Febrile, HIV infection, late presentation, CD4, risk factors.
Prendushi-Frasheri Xhensila, Kraja Dhimiter, Shpata Vjollca, Harxhi Arjan , Pilaca Arben, Pipero Pellumb, Shkurti-Leka Klodiana, Dervishi Marjeta, Shkjezi Renata, Como Najada. LATE PRESENTATION AMONG A COHORT OF FEBRILE PEOPLE NEWLY HIV INFECTED DIAGNOSED, DURING 2005-2012, IN ALBANIA International Journal of Current Research and Review. 6(14), July, 58-70
1. Leombruni P, Fassino S, Lavagnino L, Orofino G, Morosini P, Picardi A. The role of anger in adherence to highly active antiretroviral treatment in patients infected with HIV. Psychother Psychosom. 2009;78:254–57.
2. Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1- infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009;373: 1352–63.
3. Larson BA, Brennan A, McNamara L, Long L, Rosen S, Sanne I, et al. Lost opportunities to complete CD4? Lymphocyte testing among patients who tested positive for HIV in South Africa. Bull World Health Organ. 2010;88:675–80.
4. Rosen S, Fox M, Larson B. From HIV testing to treatment initiation: the missing link. In: 18th Conference on retroviruses and opportunistic infections (CROI), Boston, MA; 2011.
5. Manga NM, Diop SA, Ndour CT, Dia NM, Mendy A, Coudec M, et al. Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors. Med Mal Infect. 2009;39:95.
6. Harling G, Orrell C, Wood R. Healthcare utilization of patients accessing an African national treatment program. BMC Health Serv Res. 2007;7:80.
7. Sall L, Salamon E, Allgulander C, OweLarsson B. Psychiatric symptoms and disorders in HIV infected mine workers in South Africa. A retrospective descriptive study of acute first admissions. Afr J Psychiatry. 2009;12:206–12.
8. Kigozi IM, Dobkin LM, Martin JN, Geng EH, Muyindike W, Emenyonu NI, et al. Latedisease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in subSaharan Africa. J Acquir Immune Defic Syndr. 2009;52:280–89.
9. Girardi E, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46(1):3–8.
10. Mussini C, Manzardo C, Johnson M, Monforte AdA, Uberti-Foppa C, Antinori A, et al. Patients presenting with AIDS in the HAART era: a collaborative cohort analysis. AIDS. 2008;22:2461–69.
11. Bonjour MA, Montagne M, Zambrano M, Molina G, Lippuner C, Wadskier FG, et al. Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a casecase comparison. AIDS Res Ther. 2008;5:6.
12. Carrizosa CM, Blumberg EJ, Hovell MF, Martinez-Donate AP, Garcia-Gonzalez G, Lozada R, et al. Determinants and prevalence of late HIV testing in Tijuana, Mexico. AIDS Patient Care STDS. 2010;24:333–40.
13. Chadborn TR, Delpech VC, Sabin CA, Sinka K, Evans BG. The late diagnosis and consequent short-term mortality of HIV infected heterosexuals (England and Wales, 2000–2004). AIDS.2006;20:2371–79.
14. Iliyasu Z, Abubakar IS, Kabir M, Aliyu MH. Knowledge of HIV/AIDS and attitude towards voluntary counselling and testing among adults. J Natl Med Assoc. 2006;98:1917–22.
15. Hanna DB, Gupta LS, Jones LE, Thompson DM, Kellerman SE, Sackoff JE. AIDSdefining opportunistic illnesses in the HAART era in New York City. AIDS Care. 2007;19:264–72.
16. Lee JH, Kim GJ, Choi BS, Hong KJ, Heo MK, Kim SS, et al. Increasing late diagnosis in HIV infection in South Korea: 2000–2007. BMC Public Health. 2010;10:411.
17. Lemoh C, Guy R, Yohannes K, Lewis J, Street A, Biggs B, et al. Delayed diagnosis of HIV infection in Victoria 1994 to 2006. Sex Health. 2009;6:117–22.
18. Baker JV, Peng G, Rapkin J, Abrams DI, Silverberg MJ, MacArthur RD, et al. CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS. 2008;22:841–48.
19. Moore RD, Keruly JC. CD4 cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis. 2007;44:441–46.
20. Taiwo BO, Li X, Palella F, Jacobson LP, Margolick JB, Detels R, et al. Higher risk of AIDS or death in patients with lower CD4 cell counts after virally suppressive HAART. HIV Med. 2009;10:657–60.
21. Aiuti F, Mezzaroma I. Failure to reconstitute CD4 T-cells despite suppression of HIV replication under HAART. AIDS Rev. 2006;8:88–97.
22. Auld AF, Mbofana F, Shiraishi RW, Sanchez M, Alfredo C, Nelson LJ, et al. Four-year treatment outcomes of adult patients enrolled in Mozambique‘s rapidly expanding antiretroviral therapy program. PLoS One. 2011;6:e18453.
23. Egger M, Hirschel B, Francioli P, Sudre P, Wirz M, Flepp M, et al. Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. Swiss HIV Cohort Study. BMJ. 1997;315(7117):1194–99.
24. Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.
25. Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22–29
26. Mocroft A, Lundgren JD, Sabin ML, Monforte AdA, Brockmeyer N, Casabona J, et al. Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med. 2013;10(9):e1001510.
27. Krentz HB, Gill MJ. The Direct Medical Costs of Late Presentation (<350/mm) of HIV Infection over a 15–Year Period. AIDS Res Treat. 2012;2012:757135.
28. Delpierre C, Dray-Spira R, Cuzin L, Marchou B, Massip P, Lang T, et al. Correlates of late HIV diagnosis: implications for testing policy. Int J STD AIDS. 2007;18(5):312–17
29. Borghi V, Girardi E, Bellelli S, Angeletti C, Mussini C, Porter K, et al. Late presenters in an HIV surveillance system in Italy during the period 1992–2006. J Acquir Immune Defic Syndr. 2008;49(3):282–86.
30. Wolbers M, Bucher HC, Furrer H, Rickenbach M, Cavassini M, Weber R, et al. Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study. HIV Med. 2008;9(6):397–405.
31. Iwuji CC, Churchill D, Gilleece Y, Weiss HA, Fisher M. Older HIV infected individuals present late and have a higher mortality: Brighton, UK cohort study. BMC Public Health. 2013;13:397.
32. Zoufaly A, an der Heiden M, Marcus U, Hoffmann C, Stellbrink H, Voss L, et al. Late presentation for HIV diagnosis and care in Germany. HIV Med. 2012;13(3):172–81.
33. Baratin D, Marceillac E, Trepo C, Cotte L, Peyramond D, Chidiac C, et al. Characteristics of patients diagnosed with AIDS shortly after first detection of HIV antibodies in Lyon University hospitals from 1985 to 2001. HIV Med. 2004;5(4):273–77.
34. Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al. Late presentation of HIV infection: a consensus definition. HIV Med. 2011;12(1):61–64.
35. The HIV in Europe Initiative. http:// www.hiveurope.eu . Accessed November 2009. Havlir D, Beyrer C. The beginning of the end of AIDS. N Eng J Med. 2012;367:685–87.
36. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.
37. Kouyos RD, von Wyl V, Yerly S, Böni J, Rieder P, Joos B, et al. Ambiguous nucleotide calls from population-based sequencing of HIV-1 are a marker for viral diversity and the age of infection. Clin Infect Dis.2011;52(4):532-39.
38. Dickson N, McAllister S, Sharples K, Paul C. Late presentation of HIV infection among adults in New Zealand: 2005–2010. HIV Med. 2012;13:182–89.
39. Wohlgemut J, Lawes T, Laing RB. Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study. BMC Infect Dis. 2012;12:72.
40. D‘Arminio Monforte A, Cozzi-Lepri A, Girardi E, Castagna A, Mussini C, Di Giambenedetto S, et al. Late presenters in new HIV diagnoses from an Italian cohort of HIVinfected patients: prevalence and clinical outcome. Antivir Ther. 2011;16:1103– 12.
41. Cevallos Garc´a C, Verdejo Orte´s J, Mart?´nez Rodr´guez S, Izarra Pe´rez C. Late diagnosis of human immuno deficiency virus infection in the madrid region (2007–2011). Rev Esp Salud Publica. 2012;86:37–47
42. Tey JS, Ang LW, Tay J, Cutter JL, James L, Chew SK, et al. Determinants of late-stage HIV disease at diagnosis in Singapore, 1996 to 2009. Ann Acad Med Singapore. 2012;41:194–99.
43. Likatavicius G, van de Laar MJ. HIV infection and AIDS in the European Union and European Economic Area, 2010. Euro Surveill. 2011;16:(48):pii=20030. http://www.eurosurveillance.org/ViewArticle. aspx ArticleId=20030
44. Ndiaye B, Salleron J, Vincent A, Bataille P, Bonnevie F, Choisy P, et al. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997–2007. BMC Infect Dis. 2011;11:11.
45. Girardi E, Sampaolesi A, Gentile M, Nurra G, Ippolito G. Increasing proportion of late diagnosis of HIV infection among patients with AIDS in Italy following introduction of combination antiretroviral therapy. J Acquir Immune Defic Syndr. 2000;25:71–76.
46. World Health Organization (WHO)/Joint United Nations Programme on HIV/AIDS (UNAIDS). 2006. WHO and UNAIDS Secretariat Statement on HIV Testing and Counseling. Geneva: WHO/UNAIDS. http://data.unaids.org/pub/ExternalDocument/ 2007/20070905_rghr_statement_testing_en.pd f Accessed 18 Sept 2007.
47. Centers for Disease Control and Prevention: HIV prevalence estimates–United States, 2006. Morb Mortal Wkly Rep. 2008;57:1073– 76.
48. EuroHIV European Center for the Epidemiological Monitoring of HIV/AIDS,HIV/AIDS Surveillance in Europe, End-Year Report 2006.-2007, No 75. http:// www.invs.sante.fr/publications/2007/eurohiv_ 75/eurohiv_75.pdf. Accessed December 2007.
49. Metallidis S, Pilalas D, Skoura L, Haidich AB, Tsachouridou O, Papaioannou M, Chrysanthidis T, et al. Time trends and correlates of late presentation for HIV care in Northern Greece during the decade 2000 to 2010. Journal of the International AIDS Society 2012;15(2):17395.
50. Hellenic Centre for Disease Control and Prevention. Athens: HIV/AIDS Surveillance Report in Greece. 2010;25. http://www.keelpno.gr. Accessed October 31, 2010.
51. Monforte AD, Cozzi-Lepri A, Giradi E, Castagna A, Mussini C, Di Giambenedetto S, Galli M, Cassola G, Vullo V, et al. Icona Foundation Study Group. Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther 2011;16:1103-1112.
52. Camoni L, Raimondo M, Regine V, Salfa MC, Suligoi B and the regional representatives of the HIV Surveillance System. Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011. BMC Public Health 2013;13:281.
53. Longo B, Camoni L, Boros S, Suligoi B. Increasing proportion of AIDS diagnoses among older adults in Italy. AIDS Patient Care STDs 2008;22:365-71.
54. Smith RD, Delpech VC, Brown AE, Rice BD. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 2010;24:2109-2115.
55. Dickson NP, Mcallister S, Sharples K, Paul C. Late presentation of HIV infection among adults in New Zealand: 2005-2010. HIV Medicine 2012;13:182-189.
56. Gott CM. Sexual activity and risk-taking in later life. Health Soc Care Commun 2001;9:72-78.
57. European Centre for Disease Prevention and Control. HIV Indicator Conditions: Guidance for implementing routine HIV testing in Adults.
58. http://www.hiveurope.eu/ LinkClick.aspx?fileticket=b8rDoBh8NjM=&t abid=37. Accessed July 2013.
59. Egger M, May M, Chene G et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002;360:119– 29.
60. Antiretroviral Therapy Cohort Collaboration. Importance of baseline prognostic factors with increasing time since initiation of highly active antiretroviral therapy: collaborative analysis of cohorts of HIV-1-infected patients.Journal of Acquired Immune Deficiency Syndromes 2007;46:607–15.
61. Baggaley R: HIV for non-HIV specialists, diagnosing the undiagnosed. [http://www.medfash.org.uk/uploads/files/p17 am0h8v510dr1f941ebg1sicgpr.pdf].
62. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447– 50.
63. Sabin CA, Smith CJ, Gumley H, Murphy G, Lampe FC, Phillips AN, et al. Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy. AIDS. 2004;18:2145– 51.
64. Lucas SB, Curtis H, Johnson MA. National review of deaths among HIV infected adults. Clin Med. 2008;8:250–52.
65. Fleishman JA, Yehia BR, Moore RD, Gebo KA. The economic burden of late entry into medical care for patients with HIV infection. Med Care. 2010;48:1071–79.
66. Centers for Disease Control and Prevention (CDC). Adoption of protective behaviors among persons with recent HIV infection and diagnosis—Alabama, New Jersey, and Tennessee, 1997–1998. Morb Mortal Wkly Rep. 2000;49:512–15.
67. Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, WabwireMangen F, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV- 1-discordant couples in Rakai, Uganda. Lancet. 2001;357:1149–53.
68. Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al. Viral load and heterosexual transmission of human immunodefi ciency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342:921–29.
69. Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23:1397–404.