Cross-Sectional Analysis of Late HAART Initiation in Latin America and the Caribbean: Late Testers and Late PresentersReport as inadecuate




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Background

Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator LHI in this region.

Methodology

Cross-sectional analysis from 9817 HIV-infected treatment-naïve patients initiating HAART at 6 sites Argentina, Chile, Haiti, Honduras, Peru and Mexico from October 1999 to July 2010. LHI had CD4+ count ≤200cells-mm3 prior to HAART. Late testers LT were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters LP initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed.

Principal Findings

Among subjects starting HAART n = 9817 who had baseline CD4+ available n = 8515, 76% were LHI: Argentina 56%95%CI:52–59, Chile 80%95%CI:77–82, Haiti 76%95%CI:74–77, Honduras 91%95%CI:87–94, Mexico 79%95%CI:75–83, Peru 86%95%CI:84–88. The proportion of LHI statistically changed over time except in Honduras p≤0.02; Honduras p = 0.7, with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses CSA. Older patients were more likely LHI in Argentina and Peru OR 1.21 per +10-year of age, 95%CI:1.02–1.45; OR 1.20, 95%CI:1.02–1.43; respectively, but not in CSA OR 1.07, 95%CI:0.94–1.21. Higher education was associated with decreased risk for LHI in Chile OR 0.92 per +1-year of education, 95%CI:0.87–0.98 similar trends in Mexico, Peru, and CSA. LHI with date of HIV-diagnosis available, 55% were LT and 45% LP.

Conclusion

LHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation are needed to maximize benefits from HAART in the region.



Author: Brenda Crabtree-Ramírez, Yanink Caro-Vega, Bryan E. Shepherd, Firas Wehbe, Carina Cesar, Claudia Cortés, Denis Padgett, Serena

Source: http://plos.srce.hr/



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