Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

Background

Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages.

Methods

We collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm³ or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing.

Results

Of the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003.

Conclusion

A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups.

Incidence rate and risk factors for loss to follow-up in HIV-infected patients from five French clinical centres in Northern France - January 1997 to December 2006

BACKGROUND

Our goal was to determine the incidence rate and risk factors for loss to follow-up (LTFU) of HIV-infected patients in Northern France.

METHODS

We estimated the incidence rate of LTFU in 1,007 HIV-infected patients under care from January 1997 to December 2006. We then investigated potential risk factors for LTFU at inclusion and during follow-up.

RESULTS

The incidence of LTFU was estimated to be 3.5 per 100 person-years. Risk factors for LTFU at enrolment in a multivariate Cox model were age <30 years (hazard ratio [HR] 1.66 versus >40 years, 95% confidence interval [CI] 1.04-2.64), transmission by injection drug use (HR 5.26 versus men who have sex with men, 95% CI 2.90-9.52), no phone number provided (HR 5.4, 95% CI 3.6-8.2), no primary care physician (HR 2.10, 95% CI 1.25-3.52) and sub-Saharan African origin (HR 2.09, 95% CI 1.36-3.22). Patients with CD4(+) T-cell counts <200 cells/mm(3) (HR 0.49 versus >/=350 cells/mm(3), 95% CI 0.32-0.76) and 200-349 cells/mm(3) at baseline (HR 0.63 versus >/=350 cells/mm(3), 95% CI 0.41-0.98) had a decreased risk of LTFU. During follow-up, the risk of LTFU increased when the most recent CD4(+) T-cell count was <200 cells/mm(3) (HR 2.06, 95% CI 1.16-3.66), the patient was not on highly active antiretroviral therapy (HAART; HR 4.20, 95% CI 2.66-6.61) and the patient was on HAART but had a detectable viral load (HR 1.92, 95% CI 1.19-3.01).

CONCLUSIONS

Our findings will help clinicians recognize patients who require additional support for retention in care, including younger patients, injection drug users, people of sub-Saharan African origin, patients who are healthier at enrolment and patients who do not adhere to HAART during follow-up.

Incidence rate and risk factors for loss to follow-up in HIV-infected patients from five French clinical centres in Northern France – January 1997 to December 2006

Background

Our goal was to determine the incidence rate and risk factors for loss to follow-up (LTFU) of HIV-infected patients in Northern France.

Methods

We estimated the incidence rate of LTFU in 1,007 HIV-infected patients under care from January 1997 to December 2006. We then investigated potential risk factors for LTFU at inclusion and during follow-up.

Results

The incidence of LTFU was estimated to be 3.5 per 100 person-years. Risk factors for LTFU at enrolment in a multivariate Cox model were age <30 years (hazard ratio [HR] 1.66 versus >40 years, 95% confidence interval [CI] 1.04–2.64), transmission by injection drug use (HR 5.26 versus men who have sex with men, 95% CI 2.90– 9.52), no phone number provided (HR 5.4, 95% CI 3.6–8.2), no primary care physician (HR 2.10, 95% CI 1.25–3.52) and sub-Saharan African origin (HR 2.09, 95% CI 1.36–3.22). Patients with CD4+ T-cell counts <200 cells/mm3 (HR 0.49 versus ≥350 cells/mm3, 95% CI 0.32– 0.76) and 200– 349 cells/mm3 at baseline (HR 0.63 versus ≥350 cells/mm3, 95% CI 0.41–0.98) had a decreased risk of LTFU. During follow-up, the risk of LTFU increased when the most recent CD4+ T-cell count was <200 cells/ mm3 (HR 2.06, 95% CI 1.16–3.66), the patient was not on highly active antiretroviral therapy (HAART; HR 4.20, 95% CI 2.66–6.61) and the patient was on HAART but had a detectable viral load (HR 1.92, 95% CI 1.19–3.01).

Conclusions

Our findings will help clinicians recognize patients who require additional support for retention in care, including younger patients, injection drug users, people of sub-Saharan African origin, patients who are healthier at enrolment and patients who do not adhere to HAART during follow-up.