International Journal of Current Research and Review
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IJCRR - Vol 06 Issue 14, July, 2014

Pages: 58-70

Date of Publication: 30-Nov--0001


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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

Category: Healthcare

Abstract: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.

Full Text:

INTRODUCTION
Early commencement of antiretroviral treatment (ART) for persons living with human immune deficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) can be beneficial and can save money in the long run (1,2). The benefits are better realized when people present early at each stage along the continuum of care, from early screening / testing for HIV infection, early linkage into care by those with confirmed HIV infection, to remaining in pre-ART care until timely treatment commencement decisions are made and, thereafter, maintaining high fidelity to essential long-term care and treatment contact (3,4) . Advanced HIV disease is evidenced by compromised immune status (often with CD4+ cell count<200 cells/ml3 ), the presence of multiple co-morbid opportunistic infections, and poor overall functional and mental health status (3,5–13) . Despite global advances in access to care, a significant proportion (20–60%) of adults in most parts of the globe who come for the first time to HIV/AIDS care and treatment facilities, present with advanced HIV disease (5,14–17). Evidence from immune recovery studies indicate that, even with efficacious therapies, presenting late for HIV diagnosis results in less favourable outcomes (18– 22) . Untreated infection with the human immunodeficiency virus (HIV) progressively destroys the immune system leading to opportunistic illnesses and death. Since potent combination antiretroviral therapy (ART) has been introduced, morbidity and mortality of HIVinfected people has drastically improved(23–25) . However, a substantial proportion of individuals are not aware of their HIV infection or do not present for care and treatment until the disease is advanced(26). Late initiation of cART results in less favourable outcomes(2,18,21) and is associated with increased medical costs(27). Furthermore, untreated people may contribute to the spread of HIV for many years. In Europe, 33% to 42% and 49% to 54% of individuals were reported not to be diagnosed with HIV until having CD4 cell count values below 200 cells/mm3 (13, 28-30) and 350 cells/mm3 (26, 31, 32), respectively, and up to 30% present with an acquired immunodeficiency syndrome (AIDS) defining illness (33) . Unfortunately, different definitions for late presentation complicate direct comparisons of the study findings (34). A recent initiative resulted in a European consensus definition for late presentation of HIV-infected persons: Individuals presenting for care with a CD4 cell count below 350 cells/mm3 or with an AIDS-defining illness regardless of CD4 cell count should be classified as late presenters (35) . Late presentation for care comprises two entities which are believed to be quite different from each other in terms of risk factors and interventions: (I) late HIV testing, which reflects patients who are unaware of their HIV infection, and (II) delayed presentation for care, including individuals who are aware of their HIV infection but do not seek care right away.

Recently, in their paper ?The Beginning of the End of AIDS?, Havlir and Beyrer wrote: ?We are at a moment of extraordinary optimism in the response to the human immunodeficiency virus (HIV).‘ Several trials‘ results have led many to assert that control of the HIV pandemic may be achievable (36). Early initiation of antiretroviral therapy (ART) has been found to improve individual patient outcome and reduce the risk of HIV transmission to sexual partners by 96% (37) . However, diagnosis is a critical limiting factor in the treatment and control of HIV/AIDS worldwide. The objective of our study was to determine the frequency, demographic features, risk factors and outcomes of late presentation among the cohort of febrile people newly diagnosed HIV infected.

METHODS
Subjects

In total 166 HIV+ patients were admitted to Infectious Diseases Service (IDS), University Hospital Centre ?Mother Teresa? of Tirana (UHCT), from January 2001 to December 2012 and 240 febrile episodes were registered. Patients eligible for our study were them that received HIV confirmatory Western Blot test for the first time and these cases were distributed during January 2005 - December 2012 period of time.

Data collection Data on gender, patient‘s age at diagnosis moment, calendar year of HIVdiagnosis, risk factors of HIV infection transmission, patient living place, CD4 cell count at diagnosis, AIDSdefining events at presentation and outcome data (days of hospitalization, mortality) were extracted from patients records and registered in database. Data were recorded in the database retrospectively until 2010 review of medical files and prospectively thereafter. In order to ensure that the status at presentation was actually captured, CD4 cell count and/or AIDS-defining event diagnosis had to be reported. Measurements CDC stage clinical classification model was used. The consensus definition of the European Late Presenter Consensus Group was adopted for analysis (32). According to this definition, patients who present less than 350 CD4 cells/mm3 or an AIDS-defining event are classified as late presenters (35). Those who present less than 200 CD4+ cells/mm3 or an AIDS-defining event are classified as very late presenters and are at increased risk of death (38). Late presentation for care comprises two entities which are believed to be quite different from each other in terms of risk factors and interventions: (a) late HIV testing, which reflects patients who are unaware of their HIV infection, and (b) delayed presentation for care, including individuals who are aware of their HIV infection but do not seek care right away. Only the first group was eligible and included in this study. Statistical analysis Data are presented as mean ± SD (standard deviation) for numerical variables, number (n) or percentage (%) for categorical variables. Logistic regression models were used in order to assess predictors of late presentation. Predictors that were significantly (p < 0.05) associated with late presentation in univariate analyses were introduced in the multivariate model. Results of the logistic regression were reported as odds ratio (OR) and 95% confidence interval (CI). We considered sex, transmission categories (men who have sex with men (MSM), heterosexual contact, intravenous drug user (IDU) and blood transfusions), age (<19, 20-29, 30-39, 40-49, 50- 59, 60-69, 70+ years), emigration status, year of HIV infection diagnosis and educational level in the models. Categorical data were analyzed using the Chi square test. Statistical significance was considered at the level of p ≤ 0.05. All tests were two tailed. SPSS 15.0 statistical package was used to analyze the data.

RESULTS
A total of 94 patients were diagnosed for the first time with HIV infection during the study period, 68 patients (72.3%) were male. Mean (±SD) age at diagnosis was 40.2± 12.23 years old (range: 15- 71). Distribution of patients according to age is prescribed in (Figure 1). In 68.0% (64) of the patients was reported the possible route of HIV infection transmission. The most prevalent risk factor of HIV infection transmission was heterosexual contact representing 73.4% of cases (47/64). Men having sex with men (MSM) was reported in 14.1% of cases (9/64). In total 6.2% (4/64) of the patients reported multiple transfusions in their medical history, and four patients were intravenous drug users, 6.2% (4/64) (p < 0.05). Mean (±SD) CD4 cell count at diagnosis was 123.19 ±114.23cells/mm3 ,(range from 511-1). CD4 cell count was higher among MSM group (179.0±195.2 cells/μl) in comparison with other risk groups, while transfused subjects had the lowest CD4 cell count (104.0±66.14 cells/μl) (p < 0.005) (Figure 2). The CDC clinical stage and CD4 cell count are presented in (Figure 3). In total 87 patients (92.6%) had CD4 counts < 350 cells/mm3 or a clinical AIDS-defining event at the time of their first positive HIV test result and were considered to be late or very late presenters for HIV diagnosis. According to the CD4 cell count there were 9(10.3%) late presenters subjects, 51 (58.6%) very late presenters and 27(31.0%) cases had only a clinical AIDS-defining event. [Table 1] compares the characteristics of late presenters for HIV diagnosis with those of early presenters. The proportion of late presenters among all patients receiving a first HIV diagnosis was highest in 2012: 20.69%, and lowest in 2006: 2.29%. The highest proportion of late presenters was observed in heterosexual contact group: 51.7% of all late presenters. [Table 2] present the distribution of late presenters according to the CD4 cell count. According to univariate analysis, age, male gender, heterosexual contact (95.7% of patients engaged in heterosexual relationship were late presenters) and calendar year of diagnosis were associated with late or very late presentation for HIV diagnosis. Factors associated with late presentation according to multivariate logistic analysis are presented in [Table 3]. Distribution of not late, late and very late presenters reflecting the CDC clinical stage classification is expressed in [Table 4]. Male subjects were at higher risk of ?late presentation? compared to female ones (OR = 2.08). Patients 30-39 years old were at higher risk compared to those less than 19 years old (OR = 17.6). Compared to MSM, patients in heterosexual contact transmission category were at higher risk of ?late presentation? (OR = 2.81). Compared to non-emigrant subjects, emigrant subjects were more likely to be diagnosed late (OR = 6.89). Compared to the subjects with a university degree, subjects who have attended the high school were more likely to be diagnosed late (OR = 17.3). Compared to subjects living in urban areas, subjects living in rural areas were at higher risk of ?late presentation? (OR = 1.18). Late and very late presentation were related to male sex, heterosexual relationship, age between 30 and 39 years old, emigration and living in the rural areas. In total 14.9% (13) of late presenters, died during the admission and they represented all deaths registered in our cohort. Potentially HIV-related symptoms prior to the test were present in 93.1% (81) of cases. The prevalence of the most frequent symptoms is shown in (Figure 4).

DISCUSSION
Late presentation for HIV diagnosis has been reported to be high worldwide(11,32,39–46). In Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage of disease and enter in care late. Our results showed that 92% of individuals newly diagnosed HIV infected were late presenters; among these, 58.6% were in an advanced stage of HIV disease and 31.0% was diagnosed with AIDS. The proportion of late presenters at HIV diagnosis observed in our study was higher to that reported in other European countries, this is may be due to our restricted cohort including only febrile HIV positive subjects. Globally, up to 90% of people living with HIV may be unaware of their status (47) with estimates ranging from 21 to 30% in developed nations (48,49)

In a study performed in Germany, Zoufaly et al.(32) reported, 49.5% late presenters for HIV diagnosis. An Italian cohort confirmed this, with 63% of patients being defined as diagnosed late, using the European Consensus definition (41) of these, 16% were AIDS-presenters. A study run to Greece reported a frequency 52.5% of late presenters (50) . In two above mentioned studies, predictors of being diagnosed late were older patients, heterosexuals from low prevalence country and migrants for the German cohort (32) and older age, non-Italian origin, high HIV RNA and unemployment for the Italian Cohort (41). In 2011, in Belgium, 42% of patients were diagnosed with CD4 <350/mm3 and 38% of those patients presented with AIDS. Risk factors associated to Heterosexual contact and intravenous drug use, compared to MSM, conferred increased risk by a factor of 48% and 19%, respectively. Immigrant status conferred increased risk by a factor of 65% (50). Although the HIV epidemic in Greece predominantly affects MSM, populations such as persons who inject drugs and immigrants are at higher risk for late presentation possibly due to barriers in healthcare (34,51) . The most important findings of our study can be summarized as follows: ? Late presentation for HIV diagnosis was high (92%) and related to: ? Male sex ? Heterosexual contact ? Age: being between 30 and 39 years old ? Being emigrant or living in the rural areas. All above were independent risk factors for late presentation. As already reported by other authors (52-56), older age was associated with higher risk of late presentation. Late presentation was more common among men and was associated with heterosexual exposure to HIV infection, in comparison with other risk categories. Reduced perception of individual risk and subsequent reduced uptake of HIV testing are likely to contribute to late diagnosis among heterosexual males. Several studies have shown the proportion of late diagnosis to be lower among men who have sex with men (MSM) (53,57). More testing among the (MSM) is likely to be a major reason for this, as overall they were much more likely to have had a recent HIV test (32,39–41) . In our sample, emigrants and people living in rural areas of the country were more likely to be diagnosed later, suggesting a low access to HIV testing sites, or a poor perception of exposures at risk for HIV, or the presence of cultural or socioeconomic barriers. In our study, complaining of clinical conditions associated with HIV infection was the main reason for undergoing HIV testing. Confirming the relevant role of healthcare professionals (especially general practitioners) in recommending HIV testing not only in presence of AIDS-defining diseases but also for specific HIV indicator conditions (58) . Several published studies demonstrated also that late presentation for HIV diagnosis is linked with poor outcomes. The risk increases with lower CD4 cell counts at ART initiation and remains elevated even years after initiation of ART (59,60). If a person is diagnosed early and HIV treatment is introduced early in the course of infection before severe impairment of the immune system has occurred, life-expectancy may approach that of the general population (61). In the UK, 25% of HIV infections are undiagnosed, undermining efforts to reduce transmission (62). Late diagnosis is also an important cause of HIV-related morbidity, (63) mortality (64) and healthcare costs (65). In our study death was registered in 14.9% of cases among late presenters.

The healthcare cost for late presentation goes beyond cART / outpatient care including also more inpatient care / non-ARV drugs. These costs not only reflect lifelong legacy costs of the residual morbidities from some AIDS conditions but also reflect the costs of complex social and medical issues that contributed to late presentation (27). Late presentation for HIV diagnosis also plays a significant role in ongoing HIV transmission. It was estimated that people who are unaware of their HIV positive status are responsible for more than 50% of the new HIV infections occurring in the population, mainly through engaging in highrisk behaviours. This was confirmed by a metaanalysis of 11 independent studies (62). Studies have revealed that people who are aware of their HIV-positive status are less likely to transmit the disease because early access to healthcare / treatment results subsequently in lower viral load levels and safer sexual practices (66–68). The higher the viral load, the higher the rate of transmission (69) . There are some limitations in our study. Our data are collected retrospectively and the study was designed after the data collection was ended. It‘s a limited cohort including only febrile HIV positive subjects. We were unable to assess the impact of other predictors which may be relevant, for late presentation such as socio-economical status and origin instead of living place/residence.

CONCLUSIONS
Our study suggests a high proportion of late presenters for HIV diagnosis in Albania. Considering that late presenters are at the increased risk of clinical progression and death, it‘s essential to potentiate targeted prevention efforts and HIV testing programs, in order to diagnose and treat HIV infection as early as possible and so on to reduce HIV morbidity, mortality and transmission. Development of policies and wide implementation of interventions, targeting social categories at high risk for late presentation are recommended.

ACKNOWLEDGEMENT
Authors acknowledge the immense help received from scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Ethical Clearance
This study was carried out in accordance with the Helsinki Declaration of 1975, as revised in 2000, and was approved by the ethics committee of our institution. As this was a retrospective descriptive study, and data were collected as part of patients routine care the local committee exempted the authors from the need to apply for informed consent.

References:

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.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

SCOPUS (2014, 2019, 2020, 2021 (Till June) currently under re-evaluation)

COPE guidelines for Reviewers


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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