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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2018

Open Access 01-12-2018 | Research article

“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014

Authors: Houlin Tang, Yurong Mao, Weiming Tang, Jing Han, Juan Xu, Jian Li

Published in: BMC Infectious Diseases | Issue 1/2018

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Abstract

Background

Timely HIV testing and initiation of antiretroviral therapy are two major determinants of survival for HIV-infected individuals. Our study aimed to explore the trend of late HIV/AIDS diagnoses and to assess the factors associated with these late diagnoses in China between 2006 and 2014.

Methods

We used data from the Chinese Comprehensive Response Information Management System of HIV/AIDS (CRIMS). All individuals who tested positive for HIV between 2006 and 2014 in China and were at least 15 years of age were included. A late diagnosis was defined as an instance in which an individual was diagnosed as having AIDS or WHO stage 3 or 4 HIV/AIDS, or had a CD4 cell count less than 200 cells/mm3 at the time of diagnosis.

Results

Among the 528,234 individuals (≥15 years old) newly diagnosed with HIV between 2006 and 2014, 179,700 (34.0%) people were considered to have received late diagnoses. The late diagnosis rate decreased from 33.9% in 2006 to 29.7% in 2014 (P < 0.01). Late diagnoses were more likely to be found among those who were 45–54 years old (adjusted odds ratio [aOR]: 3.25, 95% confidence interval [CI]: 3.17–3.34) or 55+ years old (OR: 2.94, 95% CI: 2.86–3.02), male (aOR: 1.15, 95% CI: 1.13,1.17), employed as a farmer or rural laborer (aOR: 1.13, 95% CI: 1.11–1.14), infected through blood or plasma transfusion (aOR: 4.18, 95% CI: 4.02, 4.35), diagnosed at hospitals (OR: 1.17, 95% CI: 1.15, 1.19), of Han ethnicity (aOR: 1.30, 95% CI: 1.28, 1.32), and married (OR: 1.12, 95% CI: 1.11,1.13). Of those people living with HIV (PLHIV) who received late diagnoses, 7.4%(8637) and 46.1%(28,462) ultimately died with or without receiving antiretroviral therapy within a year of diagnosis, respectively.

Conclusion

A large proportion of individuals with HIV/AIDS receive late diagnoses, and this proportion has witnessed a slight decline in recent years. Expanded testing is needed to increase early HIV diagnosis and antiretroviral therapy should be recommended to all diagnosed individuals as early as possible to reduce AIDS-related death.
Literature
1.
Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17.PubMed
2.
Hammer SM, Saag MS, Schechter M, et al. Treatment for adult HIV infection: 2006 recommendations of the international AIDS society--USA panel. Top HIV Med. 2006;3:827–43.
3.
Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;(13):853–60.
4.
Detels R, Muñoz A, McFarlane G, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Stud Invest JAMA. 1998;17:1497–503.
5.
Sidibé M, Loures L, Samb B. The UNAIDS 90-90-90 target: a clear choice for ending AIDS and for sustainable health and development. J Int AIDS Soc. 2016;(1):211–33.
6.
Centers for Disease Control and Prevention. (CDC). Missed opportunities for earlier diagnosis of HIV infection--South Carolina, 1997-2005. MMWR Morb Mortal Wkly Rep. 2006;47:1269–72.
7.
Centers for Disease Control and Prevention (CDC). Adoption of protective behaviors among persons with recent HIV infection and diagnosis-Alabama, New Jersey, and Tennessee, 1997-1998. MMWR Morb Mortal Wkly Rep. 2000;23:512–5.
8.
Centers for Disease Control and Prevention. (CDC). Late versus early testing of HIV--16 sites, United States, 2000-2003. MMWR Morb Mortal Wkly Rep. 2003;25:581–6.
9.
García F, de Lazzari E, Plana M, et al. Long-term CD4+ T-cell response to highly active antiretroviral therapy according to baseline CD4+ T-cell count. J Acquir Immune Defic Syndr. 2004;(2):702–13.
10.
McClelland RS, Baeten JM. Reducing HIV-1 transmission through prevention strategies targeting HIV-1-seropositive individuals. J Antimicrob Chemother. 2006;57(2):163–6.CrossRefPubMed
11.
Chamot E, Coughlin SS, Farley TA, et al. Gonorrhea incidence and HIV testing and counseling among adolescents and young adults seen at a clinic for sexually transmitted diseases. AIDS. 1999;(8):971–9.
12.
George N, Green J, Murphy S. Sexually transmitted disease rates before and after HIV testing. Int J STD AIDS. 1998;(5):291–3.
13.
Otten MW Jr, Zaidi AA, Wroten JE, et al. Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989. Am J Public Health. 1993;(4):529–33.
14.
Delpierre C, Cuzin L, Lert F. Routine testing to reduce late HIV diagnosis in France. BMJ. 2007;(7608):1354–6.
15.
Marks G, Crepaz N, Senterfitt JW, et al. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. JAIDS. 2005;(4):446–53.
16.
Mukolo A, Villegas R, Aliyu M, et al. Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward. AIDS Behav. 2013;(1):5–30.
17.
Yang B, Chan SK, Mohammad N, et al. Late HIV diagnosis in Houston/Harris County, Texas, 2000-2007. AIDS Care. 2010;6:766–74.CrossRef
18.
Brinkhof MW, Dabis F, Myer L, et al. Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ. 2008;7:559–67.
19.
Wolbers M, Bucher HC, Furrer H, et al. Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV cohort study. HIV Med. 2008;(6):397–405.
20.
Krawczyk CS, Funkhouser E, Kilby JM, et al. Factors associated with delayed initiation of HIV medical care among infected persons attending a southern HIV/AIDS clinic. South Med J. 2006;(5):472–81.
21.
Bamford LP, Ehrenkranz PD, Eberhart MG, et al. Factors associated with delayed entry into primary HIV medical care after HIV diagnosis. AIDS. 2010;24(6):928–30.CrossRefPubMed
22.
Diez M. Late diagnosis of HIV infection. Revista Espanola de Sanidad Penitenciaria. 2011;2:35–7.
23.
Girardi E, Sabin CA, Monforte AA. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46(Suppl 1):S3–8.CrossRefPubMed
24.
MOH, UNAIDS, WHO. Update on the HIV/AIDS epidemic and response in China. 2011. Chinese.
25.
Tucker JD, Yang L-G, Yang B, et al. Prior HIV testing among STD patients in Guangdong Province, China: opportunities for expanding detection of sexually transmitted HIV infection. Sex Transm Dis. 2012;(3):182–7.
26.
Ma Y, Zhang F, Zhao Y, et al. Cohort profile: the Chinese national free antiretroviral treatment cohort. Int J Epidemiol. 2010;4:973–9.CrossRef
27.
Zhang Y, Dou Z, Sun K, et al. Association between missed early visits and mortality among patients of China National Free Antiretroviral Treatment Cohort. J Acquir Immune Defic Syndr. 2012;(1):59–67.
28.
Jiang Y, Qiu M, Zhang G, et al. Quality assurance in the HIV/AIDS laboratory network of China. Int J Epidemiol. 2010;39(Suppl 2):ii72–8.PubMedPubMedCentral
29.
Zhang F, Dou Z, Ma Y, et al. Five-year outcomes of the China national free antiretroviral treatment program. Ann Intern Med. 2009;(4):241–51.
30.
Grigoryan A, Hall HI, Durant T, et al. Late HIV diagnosis and determinants of progression to AIDS or death after HIV diagnosis among injection drug users, 33 US states, 1996-2004. PLoS One. 2009;2:e4445.CrossRef
31.
Wohl AR, Tejero J, Frye DM. Factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles. AIDS Care. 2009;(9):1203–10.
32.
Chadborn TR, Delpech VC, Sabin CA, et al. The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000-2004). AIDS. 2006;(18):2371–9.
33.
Centers for Disease Control and Prevention (CDC). Evolution of HIV/AIDS prevention programs--United States, 1981-2006. MMWR Morb Mortal Wkly Rep. 2006;21:597–603.
34.
Bunnell R, Mermin J, De Cock KM. HIV prevention for a threatened continent: implementing positive prevention in Africa. JAMA. 2006;(7):855–8.
35.
Levi J. Ensuring timely access to care for people with HIV infection: a public health imperative. Am J Public Health. 2002;(3):339–40.
36.
Scognamiglio P, Chiaradia G, Carli GD, et al. The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis. BMC Infect Dis. 2013;13:473.CrossRefPubMedPubMedCentral
37.
Camoni L, Raimondo M, Regine V, et al. Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011. BMC Public Health. 2013;(1):1–6.
38.
39.
Ma Y, Dou Z, Guo W, et al. The Human Immunodeficiency Virus Care Continuum in China:1985–2015. Clin Infect Dis. 2018;6:833–9.CrossRef
40.
41.
Saracino A, Tartaglia A, Trillo G, et al. Late presentation and loss to follow-up of immigrants newly diagnosed with HIV in the HAART era. J Immigr Minor Health. 2014;(4):751–5.
42.
Liu Y, Wu Z, Mao Y, et al. Quantitatively monitoring AIDS policy implementation in China. Int J Epidemiol. 2010;39(Suppl 2):ii90–6.PubMedPubMedCentral
43.
Mugavero MJ, Castellano C, Edelman D, et al. Late diagnosis of HIV infection: the role of age and sex. Am J Med. 2007;(4):370–3.
44.
Delpierre C, Cuzin L, Lauwers-Cances V, et al. High-risk groups for late diagnosis of HIV infection: a need for rethinking testing policy in the general population. AIDS Patient Care STDs. 2006;(12):838–47.
45.
Schwarcz S, Hsu L, Dilley JW, et al. Late diagnosis of HIV infection: trends, prevalence, and characteristics of persons whose HIV diagnosis occurred within 12 months of developing AIDS. J Acquir Immune Defic Syndr. 2006;(4):491–4.
46.
Zhang XF, Liu XZ, Tao XR, et al. The epidemiological study on human immunodeficiency virus infection among paid blood donors living in Shandong provincial China comprehensive response project areas. Zhonghua Liu Xing Bing Xue Za Zhi 2005;5:314–316. Chinese.
47.
Zhao F, Wang Z, Li WJ. Human immunodeficiency virus type 1 subtypes prevalence in Central China. Yonsei Med J. 2009;(5):644–9.
48.
49.
50.
Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, Young J, Psichogiou M, et al. CD4 cell count and the risk of AIDS or death in HIV-infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE. PLoS Med. 2012;3:e1001194.
51.
Guiguet M, Boue F, Cadranel J, et al. Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study. Lancet Oncol. 2009;(12):1152–9.
52.
53.
Long EF, Brandeau ML, Owens DK. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med. 2010;(12):778–89.
54.
Wu Z, Wang Y, Mao Y, et al. The integration of multiple HIV/AIDS projects into a coordinated national programme in China. Bull World Health Organ. 2011;(3):227–33.
55.
Thanawuth N, Chongsuvivatwong V. Late HIV diagnosis and delay in CD4 count measurement among HIV-infected patients in southern Thailand. AIDS Care. 2008;(1):43–50.
56.
Tang H, Mao Y, Shi CX, et al. Baseline CD4 cell counts of newly diagnosed HIV cases in China: 2006-2012. PLoS One. 2014;6:e96098.CrossRef
57.
Wu Z. New challenge and complex situation on HIV/AIDS control and prevention in China. Chin J Public Health. 2011;12:1505–7. Chinese
58.
Rothman KJ, Greenland S, Lash TL. Chapter 9. Validity in epidemiologic methods. Lippincott Williams & Wilkins. 2008:p352–8.
Metadata
Title
“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014
Authors
Houlin Tang
Yurong Mao
Weiming Tang
Jing Han
Juan Xu
Jian Li
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2018
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-018-3158-x

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