1
|
Siwak E, Horban A, Witak-Jędra M, Cielniak I, Firląg-Burkacka E, Leszczyszyn-Pynka M, Witor A, Muller K, Bociąga-Jasik M, Kalinowska-Nowak A, Gąsiorowski J, Szetela B, Jabłonowska E, Wójcik-Cichy K, Jankowska J, Lemańska M, Olczak A, Grąbczewska E, Grzeszczuk A, Rogalska-Plonska M, Suchacz M, Mikuła T, Łojewski W, Bielec D, Kocbach P, Błudzin W, Parczewski M. Long-term trends in HIV care entry: over 15 years of clinical experience from Poland. HIV Med 2019; 20:581-590. [PMID: 31250958 DOI: 10.1111/hiv.12762] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. METHODS Cross-sectional data were collected for 3972 HIV-infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000-2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/μL or history of AIDS-defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/μL or history of AIDS) were identified. RESULTS The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46-4.47] for late presentation and 3.13 (95% CI 1.49-6.58) for advanced disease for the 21-30-year-old category to 5.2 (95% CI 1.94-14.04) and 8.15 (95% CI 2.88-23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16-2.60) and 1.55 (95% CI 1.05-2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31-0.59) and 0.39 (95% CI 0.29-0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. CONCLUSIONS Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.
Collapse
Affiliation(s)
- E Siwak
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - A Horban
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland.,Department for Adults Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Witak-Jędra
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - I Cielniak
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - E Firląg-Burkacka
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - M Leszczyszyn-Pynka
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - A Witor
- Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland
| | - K Muller
- Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland
| | - M Bociąga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - A Kalinowska-Nowak
- Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - J Gąsiorowski
- Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - B Szetela
- Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - E Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - K Wójcik-Cichy
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - J Jankowska
- Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, HIV Outpatient Clinic, Gdańsk, Poland
| | - M Lemańska
- Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, HIV Outpatient Clinic, Gdańsk, Poland
| | - A Olczak
- Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - E Grąbczewska
- Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - A Grzeszczuk
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - M Rogalska-Plonska
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - M Suchacz
- Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - T Mikuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - W Łojewski
- Department of Infectious Diseases, Regional Hospital in Zielona Góra, Zielona Góra, Poland
| | - D Bielec
- Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland
| | - P Kocbach
- Clinical Ward of Infectious Diseases, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - W Błudzin
- Department of Infectious Diseases, Regional Hospital in Opole, Opole, Poland
| | - M Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
2
|
Flisiak R, Wiercińska-Drapało A, Bociąga-Jasik M, Barałkiewicz G, Grzeszczuk A, Olczak A, Grąbczewska E, Parczewski M, Jabłonowska E, Dąbrowska M, Kozłowska J, Mikuła T, Witor A, Gąsiorowski J, Latarska-Smuga D, Ścibiorski C, Knysz B. Metabolic abnormalities and cardiovascular risk in HIV-infected cohort of patients treated with protease inhibitors. HIV & AIDS Review 2015. [DOI: 10.1016/j.hivar.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|