Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010.

Abstract

INTRODUCTION:

Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated.

METHODS:

A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm(3) or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm(3) or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods.

RESULTS:

Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm(3) (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD.

CONCLUSION:

The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed.

• Authors: Melissa Bianchetti Valentini, Maria Luíza Guerra de Toledo, Marise Oliveira Fonseca, Laura Maria Silva Thiersch, Ingrid Silva Bremer de Toledo, Flávia Cristina Jácome Machado, Unaí Tupinambás
• Journal: The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (Braz J Infect Dis) 2015 May-Jun Vol. 19 Issue 3 Pg. 253-62 ISSN: 1678-4391 [Electronic] Brazil
• PMID: 25769736 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Topics

• Adult
• Brazil
• CD4 Lymphocyte Count
• Cross-Sectional Studies
• Delayed Diagnosis
• Disease Progression
• Female
• HIV Infections (diagnosis, drug therapy)
• Humans
• Male
• Patient Acceptance of Health Care (statistics & numerical data)
• Risk Factors
• Socioeconomic Factors
• Time Factors
• Viral Load