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AIDS Res Hum Retroviruses. 2016 Mar;32(3):255-61. doi: 10.1089/AID.2015.0058. Epub 2015 Oct 15.

Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD.

Author information

1
1 Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine , Seoul, Korea.
2
2 University of Malaya Medical Centre , Kuala Lumpur, Malaysia .
3
3 Research Institute for Health Sciences, Chiang Mai University , Chiang Mai, Thailand .
4
4 Department of Infectious Diseases, Tan Tock Seng Hospital , Singapore, Singapore .
5
5 The Kirby Institute , UNSW Australia, Sydney, Australia .
6
6 National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences , Phnom Penh, Cambodia .
7
7 National Hospital for Tropical Diseases , Hanoi, Vietnam .
8
8 Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand .
9
9 Queen Elizabeth Hospital , Hong Kong, China .
10
10 Faculty of Medicine Udayana University and Sanglah Hospital , Bali, Indonesia .
11
11 Bach Mai Hospital , Hanoi, Vietnam .
12
12 Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital , Jakarta, Indonesia .
13
13 Research Institute for Tropical Medicine , Manila, Philippines .
14
14 YRGCARE Medical Centre, VHS , Chennai, India .
15
15 Beijing Ditan Hospital, Capital Medical University , Beijing, China .
16
16 Taipei Veterans General Hospital , Taipei, Taiwan .
17
17 Hospital Sungai Buloh , Sungai Buloh, Malaysia .
18
18 Institute of Infectious Diseases , Pune, India .
19
19 Chiangrai Prachanukroh Hospital , Chiang Rai, Thailand .
20
20 HIV-NAT/Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
21
21 Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand .
22
22 National Center for Global Health and Medicine , Tokyo, Japan .
23
23 Hospital Raja Perempuan Zainab II , Kota Bharu, Malaysia .
24
24 TREAT Asia, amfAR-The Foundation for AIDS Research , Bangkok, Thailand .

Abstract

Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003-2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/μl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31-40, 41-50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31-1.88; OR = 2.01, 95% CI 1.58-2.56; and OR = 1.69, 95% CI 1.23-2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42-3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35-0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36-0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care.

PMID:
26414065
PMCID:
PMC4779961
DOI:
10.1089/AID.2015.0058
[Indexed for MEDLINE]
Free PMC Article

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