Late presenters to HIV treatment-associated risk factors in India

[Guest guest]

Late presenters to HIV care and treatment, identification of associated risk

factors in HIV-1 infected Indian population

Kamalika Mojumdar , Madhu Vajpayee , Neeraj K Chauhan and Sanjay Mendiratta

Department of Microbiology, All India Institute of Medical Sciences, New Delhi,

India

BMC Public Health 2010, 10:416doi:10.1186/1471-2458-10-416

Published: 13 July 2010

Abstract

Background

Timely access to antiretroviral therapy is a key to controlling HIV infection.

Late diagnosis and presentation to care diminish the benefits of antiretrovirals

and increase risk of transmission. We aimed to identify late presenters in

patients sent for first CD4 T cell count after HIV diagnosis, for therapy

initiation evaluation. Further we aimed at identifying patient factors

associated with higher risk of late presentation.

Methods

Retrospective data collection and analysis was done for 3680 subjects visiting

the laboratory for CD4 T cell counts between 2001 and 2007. We segregated the

patients on basis of their CD4 T cell counts after first HIV diagnosis. Factors

associated with risk of late presentation to CD4 T cell counts after HIV

diagnosis were identified using univariate analysis, and the strength of

association of individual factor was assessed by calculation of odds ratios.

Results

Of 3680 subjects, 2936 (83.37%) were defined as late presenters.

Late testing varied among age groups, transmission categories, and gender. Males

were twice as likely to present late as compared to females. We found

significant positive association of heterosexual transmission route (p < 0.001),

and older age groups of 45 years and above (p = 0.0004) to late presentation.

Female sex, children below 14 years of age and sexual contact with HIV positive

spouse were associated with significantly lower risks to presenting late.

Intravenous drug users were also associated with lower risks of late

presentation, in comparison to heterosexual transmission route.

Conclusions

The study identifies HIV infected population groups at a higher risk of late

presentation to care and treatment. The risk factors identified to be associated

with late presentation should be utilised in formulating targeted public health

interventions in order to improve early HIV diagnosis

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