Late Presenters of HIV Infection in an HIV Unit of a Tertiary University Hospital in a Rural Region of Greece

Barriers to Care for Newly Diagnosed HIV Patients: Insights From a Single-Centre Study

Introduction: We aimed to evaluate the clinical presentation and diagnosis process of all newly diagnosed human immunodeficiency virus (HIV) patients and conduct a 'look back' for barriers to care to aid a greater understanding of interventions to reduce late presentation. Methods: We evaluated 102 patients with newly diagnosed HIV who were referred to Melaka Hospital's infectious disease (ID) team from January 2021 to December 2022 via retrospective case record review. They were categorised into late presenters (LPs) and nonlate presenters (NLPs). LP is defined as persons presenting for care with a cluster of differentiation 4 (CD4) count below 350 cells/μL or presenting with an acquired immunodeficiency syndrome (AIDS) defining event, regardless of the CD4 cell count. Demographic characteristics, individual and healthcare system barriers and treatment outcomes were evaluated. Results: There were 89.2% of LPs, with 56.9% presenting with opportunistic infection (OI). Median CD4 for LPs upon diagnosis was 53 cells/μL. Pneumocystis jirovecii pneumonia was the most common presenting OI. Most were men who had sex with men (MSM) with more university graduates among the NLPs compared to LPs (36.4% vs. 8.8%, p 0.02). 9.9% of LPs experienced pitfalls during healthcare consultation, leading to late presentation, which was labelled as adverse events. LP's median time from diagnosis to first ID consultation was 7 days, and all patients' median duration of antiretroviral therapy (ART) initiation was 24 days. 82.4% of the patients were still on follow-up, with 69.6% achieving virological suppression at 6 months of ART. The mortality rate was 5.9%, all of which were LPs, and most were MSM. Conclusions: Late presentation remains challenging, with 9.9% of potent preventable adverse events. Morbidity meetings are crucial for immediate feedback to involved healthcare providers. Community-based organisations also play an essential role in identifying and providing linkage of high-risk groups to early HIV screening and diagnosis.

Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon

Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers' attitudes and competencies.

Quality of sleep in people living with HIV in the era of highly active antiretroviral treatment

PURPOSE

Although HIV infection has become a chronic disease, people living with HIV (PLWHIV) often develop disorders that affect their quality of life. Sleep disturbances could occur in all stages of infection and lead to fatigue, increased risk for comorbidities and reduced adherence to treatment. The aim of the present study is to evaluate the quality of sleep in PLWHIV monitored at the HIV Unit of the University General Hospital of Evros (Greece).

METHODS

Patients completed self-reported questionnaires including restless legs syndrome (RLS) questionnaire, the Epworth Scale, the Athens Insomnia Scale, the Fatigue Severity Scale (FSS), the Hospital Anxiety and Depression Scale - HADS, the SleepF Quality Scale MOS, the STOP BANG questionnaire for obstructive sleep apnoea (OSA), the Pittsburgh Sleep Quality Index and the International Physical Activity Questionnaire. Sociodemographic and anthropometric characteristics, data of HIV infection and clinical factors were recorded.

RESULTS

A total of 154 patients, 120 males, were included in the study. The percentage of patients diagnosed with RLS was 26.6% and the corresponding percentage of insomnia 55.2%. OSA was documented in 35% of patients. High prevalence of depression (46.1%) and anxiety (54.54%) was reported. Detectable viral load, low CD4 cell count and limited physical activity (p < 0.001) were significant risk factors for increased incidence rate of sleep disturbances. Sleep disorders were not proven to be associated with newer antiretroviral regimens.

CONCLUSIONS

Sleep disturbances were reported in high frequency in PLWHIV affecting their quality of life and increasing symptoms of depression and anxiety. It is vital to add sleep assessment into routine care and find efficient interventions in order to improve quality of life, mental health and adherence to antiretroviral treatment.