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Justice AC, Goetz MB, Stewart CN, Hogan BC, Humes E, Luz PM, Castilho JL, Nash D, Brazier E, Musick B, Yiannoutsos C, Malateste K, Jaquet A, Cornell M, Shamu T, Rajasuriar R, Jiamsakul A, Althoff KN. Delayed presentation of HIV among older individuals: a growing problem. Lancet HIV 2022; 9:e269-e280. [PMID: 35218732 PMCID: PMC9128643 DOI: 10.1016/s2352-3018(22)00003-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Late presentation for care is a major impediment to the prevention and effective treatment of HIV infection. Older individuals are at increased risk of late presentation, represent a growing proportion of people with late presentation, and might require interventions tailored to their age group. We provide a summary of the literature published globally between 2016-21 (reporting data from 1984-2018) and quantify the association of age with delayed presentation. Using the most common definitions of late presentation and older age from these earlier studies, we update this work with data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, focusing on data from 2000-19, encompassing four continents. Finally, we consider how late presentation among older individuals might be more effectively addressed as electronic medical records become widely adopted.
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Affiliation(s)
- Amy C Justice
- VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, West Haven, CT, USA.
| | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Cameron N Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brenna C Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paula M Luz
- Affiliation Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jessica L Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Denis Nash
- City University of New York Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Karen Malateste
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Antoine Jaquet
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinei Shamu
- Graduate School of Health Sciences, Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Reena Rajasuriar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Awachana Jiamsakul
- Biostatistics and Databases Program, The Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Poizot-Martin I, Lions C, Allavena C, Huleux T, Bani-Sadr F, Cheret A, Rey D, Duvivier C, Jacomet C, Ferry T, Cabie A, Fresard A, Pugliese P, Delobel P, Lamaury I, Chirouze C, Zaegel-Faucher O, Brégigeon S, Rojas Rojas T, Obry-Roguet V, Makinson A. Spectrum and Incidence Trends of AIDS- and Non-AIDS-Defining Cancers between 2010 and 2015 in the French Dat'AIDS Cohort. Cancer Epidemiol Biomarkers Prev 2020; 30:554-563. [PMID: 33310788 DOI: 10.1158/1055-9965.epi-20-1045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer risk is higher in people living with HIV (PLWH) compared with the general population, and cancers related to age are expected to be most prevalent. METHODS We determined the spectrum and incidence rates of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and of lung, Hodgkin lymphoma (HL), head and neck (HNC), colon-rectum, anal, liver, breast, prostate, and urinary bladder cancers between January 2010 and December 2015 in the French Dat'AIDS cohort. Incidence rates were calculated by year and compared using the χ 2 test for linear trend. Standardized incidence ratios [SIR (95% confidence interval)] were calculated relative to the French general population. RESULTS Among 44,642 patients, corresponding to 180,216.4 person-years (PY), 1,440 cancer cases occurred in 1,314 patients. ADC incidence was 191.4 (172.3-212.7)/105 PY and declined over time overall and in men, whereas NADC incidence was higher [548.8 (515.6-584.1)/105 PY] and did not change. In men, non-Hodgkin lymphoma was the most common cancer, but prostate cancer had the highest incidence among NADCs. Breast cancer was the most common cancer in women. SIRs were higher for cervical cancer [1.93 (1.18-3.14)], HNC in women [2.4 (1.4-4.2)], liver [overall: 3.8 (3.1-4.6); men: 3.2 (2.5-4.0); women: 12.9 (8.3-20.0)], and HL [overall: 13.8 (11.1-17.1); men: 16.2 (12.9-20.4); women: 6.2 (3.22-11.9)] but lower for lung [overall: 0.7 (0.6-0.9); men: 0.7 (0.5-0.8)], prostate [0.6 (0.5-0.7)], and breast cancers [0.6 (0.4-0.7)]. CONCLUSIONS Spectrum of NADCs has changed, with prostate and breast cancers becoming the most common despite their lower SIR. IMPACT These results confirm the need to maintain regular epidemiologic cancer monitoring in order to update screening guidelines.
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Affiliation(s)
- Isabelle Poizot-Martin
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, APHM Sainte-Marguerite, Service d'immuno-Hématologie Clinique, Marseille, France. .,Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Caroline Lions
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Clotilde Allavena
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, Nantes, France
| | - Thomas Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur - Centre Hospitalier G. DRON Tourcoing, Tourcoing, France
| | - Firouze Bani-Sadr
- Département de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, Centre Hospitalier Universitaire, Reims, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, Service de Médecine Interne - Immunologie Clinique - Hôpital Bicêtre - AP-HP, Le Kremlin-Bicêtre, France
| | - David Rey
- Le Trait d'Union, Centre de Soins de l'infection par le VIH, Hôpitaux Universitaires, Strasbourg, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France, IHU Imagine, Paris, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Christine Jacomet
- Centre Hospitalier Universitaire de Clermont-Ferrand, Département des Maladies Infectieuses et Tropicales, Clermont-Ferrand, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - André Cabie
- CHU de Martinique, Fort-de-France, Université des Antilles, EA4537, Fort-de-France, Inserm CIC1424, CHU de Martinique, Fort-de-France, France
| | - Anne Fresard
- Centre Hospitalier Universitaire de Saint-Étienne, Département des Maladies Infectieuses et Tropicales, Saint-Etienne, France
| | | | - Pierre Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, INSERM, UMR1043, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Isabelle Lamaury
- Département d'Infectiologie, Dermatologie et Immunologie Clinique, CHU Guadeloupe BP 465, Pointe-à-Pitre Cedex, France
| | - Catherine Chirouze
- Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Département des Maladies Infectieuses et Tropicales, Besançon, France
| | - Olivia Zaegel-Faucher
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Sylvie Brégigeon
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Teresa Rojas Rojas
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Véronique Obry-Roguet
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Alain Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, Montpellier, France
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Emlet CA, O'Brien KK, Fredriksen Goldsen K. The Global Impact of HIV on Sexual and Gender Minority Older Adults: Challenges, Progress, and Future Directions. Int J Aging Hum Dev 2019; 89:108-126. [PMID: 31006251 DOI: 10.1177/0091415019843456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
According to Joint United Nations Programme on HIV/AIDS (UNAIDS) data, 36.9 million people are living with HIV worldwide. Older adults, those aged 50 years and older, with HIV are increasing worldwide; however, the prevalence and incidence differ substantially across regions. The purpose of this article is to provide an overview of how HIV is impacting older adults globally, with a focus on sexual and gender minority older adults. The article is organized using the eight geographical regions from UNAIDS, with information on the prevalence and incidence among older adults. Among sexual and gender minority older adults, key risks are identified, including laws that criminalize same-sex relationships; issues of stigma and fear; and the concomitant lack of access and barriers to HIV testing, treatment, and prevention. Progress within each region toward the UNAIDS 90-90-90 targets is included, and suggestions for future directions of research and service delivery are made.
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Lions C, Cabras O, Cotte L, Huleux T, Gagneux-Brugnon A, Makinson A, Cabié A, Bonnet B, Duvivier C, Hocqueloux L, Cua E, Cheret A, Hustache-Mathieu L, Obry-Roguet V, Jacomet C, Poizot-Martin I. Missed opportunities of HIV pre-exposure prophylaxis in France: a retrospective analysis in the French DAT'AIDS cohort. BMC Infect Dis 2019; 19:278. [PMID: 30909885 PMCID: PMC6434788 DOI: 10.1186/s12879-019-3915-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016. METHODS Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. RESULTS Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). CONCLUSION With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.
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Affiliation(s)
- C. Lions
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
| | - O. Cabras
- Service des maladies infectieuses et tropicales, CHU Bichat, Paris, France
| | - L. Cotte
- Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
| | - T. Huleux
- Service Universitaire des maladies infectieuses et du voyageur, CH Tourcoing, Tourcoing, France
| | - A. Gagneux-Brugnon
- Service d’Infectiologie, CHU Sainte-Etienne, Groupe Immunité des Muqueuses et Agents Pathogènes, Institut Presage, Université de Lyon, Lyon, France
| | - A. Makinson
- Infectious and Tropical Diseases Department, University Hospital Montpellier, Montpellier, France
- UMI 233/INSERMU1175, IRD, University Montpellier, Montpellier, France
| | - A. Cabié
- Service des maladies infectieuses et tropicales, CHU de Martinique, INSERM CIC 1425 and Université des Antilles EA 4537, La Martinique, France
| | - B. Bonnet
- Maladies Infectieuses et tropicales, CHU HOTEL DIEU, Nantes, France
| | - C. Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’infectiologie Necker-Pasteur, F-75015 Paris, France
- Institut Pasteur, Centre Médical de l’Institut Pasteur, Centre d’infectiologie Necker-Pasteur, F-75015 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Equipe d’Accueil EA 7327, F-75015 Paris, France
- IHU Imagine, F-75015 Paris, France
| | - L. Hocqueloux
- Service des maladies infectieuses et tropicales, CHR d’Orléans –La Source, Orléans, France
| | - E. Cua
- Service des maladies infectieuses et tropicales, CHU de Nice, Nice, France
| | - A. Cheret
- Service de Médecine Interne, CHU Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - L. Hustache-Mathieu
- Service des maladies infectieuses et tropicales, CHU Besançon, Besançon, France
| | - V. Obry-Roguet
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
| | - C. Jacomet
- Service des maladies infectieuses et tropicales, CHU Clermont Ferrand, Clermont Ferrand, France
| | - I. Poizot-Martin
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Aix Marseille Univ, Marseille, France
- Immuno hematological Unit/ service d’Immuno- hématologie Clinique, Centre d’Informations et de Soins de l’Immunodéficience Humaine et des Hépatites virales, 270 boulevard de Sainte Marguerite, 13009 Marseille, France
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Cammarota S, Citarella A, Manzoli L, Flacco ME, Parruti G. Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:389-398. [PMID: 30087571 PMCID: PMC6061204 DOI: 10.2147/ceor.s162625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Due to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV. Methods The study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements. Results Among 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively. Conclusion The presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.
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Affiliation(s)
- Simona Cammarota
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Anna Citarella
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy.,Regional Healthcare Agency of Abruzzo, Pescara, Italy
| | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy,
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