High-Risk groups for late diagnosis of HIV infection: a need for rethinking testing policy in the general population
ABSTRACT The aim of the study was to identify high-risk groups and the determinants of late HIV diagnosis in France in the era of highly active antiretroviral therapy (HAART), from January 1996 to June 2005. Informations were collected from an electronic medical record of all HIV- 1-infected patients who sought care in six HIV reference centers in France, constituting a prospective multicentric cohort. Patients were defined as "late testers" if they had presented with either symptoms of clinical AIDS or a CD4 cell count less than 200/mm(3) during the year of diagnosis, as "nonlate" if their CD4 count was above 200, and as "unknown" if CD4 cell count in the year at the time of diagnosis was not documented. Among the 4516 patients available for analysis, the percentage of late testing was 38% (n = 1718) and decreased after 2003 (31.5% in 2004-2005). This percentage was higher in heterosexual men (48.2%) than in homosexual men (31.7%) or heterosexual women (32.6%) and was higher for patients older than 30. Heterosexual men living in a couple with children had a higher risk of late testing (odds ratio [OR] = 1.65, 95% confidence interval [CI]: 1.03 to 2.66), while heterosexual women in a couple without children had a lower risk (OR = 0.46, 95% CI: 0.25 to 0.83). Among homosexual men, unemployment was associated with late testing (OR = 2.23, 95% CI: 1.14 to 4.36). The proportion of late testing was still high. Groups classically identified as low risk for HIV infection, particularly heterosexual men in a couple with children, were found to be at high risk for late testing. It seems necessary to improve HIV testing policy in the heterosexual population.
- SourceAvailable from: Pierre Chauvin
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- "Concurrently, these data suggest that the French policies -which have focused on high risk groups (Sub-Saharan migrants as mentioned above, but also men who have sex with men and intravenous drug users) -might have missed opportunities to raise the awareness of French heterosexuals and other lower-risk groups. As a result, when infected with HIV, these populations are then at higher risk of being tested late (Delpierre, et al., 2006). "
ABSTRACT: In France, the newly diagnosed infection rate was 372/100,000 for African immigrants versus 6/100,000 for the French-born population in 2008. In addition, people from sub-Saharan countries were at higher risk for late diagnosis than native-born French despite their more frequent use of HIV testing. The purpose of this study was to compare the mean time since the last HIV test according to migration origin. This study used data from the SIRS (a French acronym for health, inequalities, and social ruptures) cohort, which, in 2005, included 3023 households representative of the greater Paris area. HIV testing uptake and the time since the last test were studied in relation to socio-economic factors, psychosocial characteristics, and migration origin. Multivariate ANOVA analyses were performed using Stata 10. People from sub-Saharan Africa were more likely to have been tested in their lifetime (78.51%) than those of French (56.19%) or Maghreb (39.74%) origin (p<0.0000). The mean time, in years, since the last HIV test was shorter among sub-Saharan immigrants and Maghreb immigrants (2.15 and 2.53 years, respectively) than among native-born French (4.84 years) (F=12.67; p<0.0000). These differences remained significant even after adjusting for gender, age, number of steady relationships, time lived in France, and difficulty reading and/or writing French (F=5.73; p=0.0007). A gender analysis revealed the same pattern for both sexes, with greater differences in the mean duration by migration origin for women. These results and recent epidemiological data seem to show that since the early 2000s, measures aimed at increasing HIV testing and decreasing late diagnosis in sub-Saharan immigrants have been effective.AIDS Care 04/2011; 23(9):1117-27. DOI:10.1080/09540121.2011.554522
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- "After HARRT was introduced in 1996, multiple determinants of survival were noted with many of these disparities attributable to differential effects of, access to, or usage of HAART therapies (Nash, Katyal, & Shah, 2005). These disparities included demographics factors such as: persons of African-American descent (Blair, Fleming & Karon, 2002; Hall, McDavid, Ling, & Sloggett, 2005; Hall, Byers, Ling, & Espinoza, 2007; Hanna, Pfeiffer, Torian, & Sackoff, 2008; Levine et al., 2007; Nash et al., 2005; Palella, Baker, Moorman, Chmiel, Wood, Brooks & Holmberg, 2006) and Hispanic race/ethnicity (Blair et al., 2002; Hall et al., 2007; Hanna et al., 2008; Nash et al., 2005); women (Hall et al., 2005; Levine et al., 2007; Nash et al., 2005); low socioeconomic status (Hanna et al., 2008; McDavid, Hall, Ling, & Song, 2007; McFarland et al., 2003; Levine et al., 2007; Rapiti, Porta, Forastiere, Fasco, & Perucci, 2000); unemployed persons (Delpierre et al., 2006); those who are publicly insured (Palella et al., 2006); and persons aged 60 and over (Nash et al., 2005). Other reasons for decreased survival rates include low CD4 count/high viral load at time of AIDS diagnoses (Hanna et al., 2008; Martinez et al., 2007); limited access to care (Cunningham et al., 2000); and lack of timely initiation of HAART and/or adherence to its medical regime (Cunningham et al., 2000; Hogg et al., 2001). "
ABSTRACT: A follow-up study was conducted on a sample of 120 ethnically diverse HIV-positive men and women first interviewed in 2000. Participant survival and death rates were ascertained from death records and analyses were performed to identify demographic and psychosocial predictors of survival from the original data. Consistent with past studies, factors associated with survival were age, CD4 count, years HIV positive, and lower alcohol use. Two analyses identified use of professional counseling as a unique factor associated with reduced risk of death. Contrary to our hypotheses, the results from these analyses did not suggest that social groups with fewer economic and institutional resources or those with limited access to highly active retroviral therapy (HAART) therapies were at reduced risk of survival.Social Work in Health Care 10/2010; 49(9):783-98. DOI:10.1080/00981381003745020
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- "In terms of public health these are missed opportunities to diagnose, treat and stop the spread of HIV infection. Our results reinforce the need to normalize HIV testing in all settings     . "
ABSTRACT: To study the prevalence of Delayed HIV Diagnosis (DHD) and its associated risk factors, to evaluate the effect of DHD on virological and immunological responses to HAART and to estimate the impact of DHD on all-causes mortality. Prospective cohort of 2, 564 HIV-positive HAART-naïve subjects attending 19 hospitals in Spain, 2004-2006. Estimations were made by logistic regression and survival analyses by Cox regression models. Prevalence of DHD was 37.3% (35.0-39.6). DHD was related to low educational level (OR:1.31, 95% CI:1.0-1.7). Compared to men who have sex with men (MSM), DHD was more frequent in heterosexuals (OR:1.9 95% CI:1.5-2.5) and injection drug users (IDUs) (OR:2.0 95% CI:1.5-2.8). An interaction between age and sex was found. Although risk of having DHD did not increase after age 30 in women, it increased linearly with age in men. No differences in virological (OR 1.2 95% CI: 0.8-1.8) and CD4 T cell (OR 1.1 95% CI: 0.7-1.8) responses to HAART were seen. The adjusted hazard ratio for death in patients with DHD was 5.2, (95% CI: 1.9-14.5). DHD is very common, especially in older men, heterosexuals and IDUs. Although we did not find differences in virological and immunological responses to HAART, we did observe higher mortality in people with DHD. Increased efforts to early diagnose HIV infection are urgently needed.Current HIV research 04/2009; 7(2):224-30.