Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the "treat all" era: a retrospective cohort study from rural Rwanda.
Delayed diagnosis
HIV
Rwanda
Test and treat
Treat all
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
25 Aug 2022
25 Aug 2022
Historique:
received:
03
03
2022
accepted:
16
08
2022
entrez:
25
8
2022
pubmed:
26
8
2022
medline:
30
8
2022
Statut:
epublish
Résumé
In 2016 Rwanda adopted "treat all" where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists. We conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm Among 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months. Presenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
In 2016 Rwanda adopted "treat all" where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists.
METHODS
METHODS
We conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm
RESULTS
RESULTS
Among 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months.
CONCLUSION
CONCLUSIONS
Presenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.
Identifiants
pubmed: 36008786
doi: 10.1186/s12879-022-07692-w
pii: 10.1186/s12879-022-07692-w
pmc: PMC9404671
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
706Informations de copyright
© 2022. The Author(s).
Références
AIDS Res Ther. 2020 Jul 10;17(1):40
pubmed: 32650797
BMC Med. 2015 Sep 09;13:216
pubmed: 26354601
South Afr J HIV Med. 2021 Aug 10;22(1):1266
pubmed: 34522428
Clin Infect Dis. 2018 Mar 4;66(suppl_2):S132-S139
pubmed: 29514234
AIDS Behav. 2016 May;20(5):1009-16
pubmed: 26346334
Ann Glob Health. 2020 Sep 14;86(1):117
pubmed: 32983913
Curr HIV/AIDS Rep. 2020 Oct;17(5):458-466
pubmed: 32844274
Curr Opin HIV AIDS. 2013 Jan;8(1):41-9
pubmed: 23188178
S Afr Med J. 2017 Nov 27;107(12):1058-1064
pubmed: 29262956
J Acquir Immune Defic Syndr. 2004 Aug 1;36(4):951-9
pubmed: 15220702
N Engl J Med. 2015 Aug 27;373(9):808-22
pubmed: 26193126
Lancet. 2007 Jul 7;370(9581):59-67
pubmed: 17617273
Epidemiology. 2010 Jan;21(1):13-5
pubmed: 20010207
J Int AIDS Soc. 2020 Jun;23(6):e25543
pubmed: 32536033
Clin Infect Dis. 2018 Mar 4;66(suppl_2):S103-SS105
pubmed: 29514231
Am J Epidemiol. 2002 Jan 15;155(2):176-84
pubmed: 11790682
N Engl J Med. 2011 Aug 11;365(6):493-505
pubmed: 21767103
PLoS Med. 2019 May 29;16(5):e1002820
pubmed: 31141516
Sci Rep. 2018 Jun 5;8(1):8594
pubmed: 29872068
WHO South East Asia J Public Health. 2017 Apr;6(1):90-93
pubmed: 28597865
Clin Infect Dis. 2013 May;56(9):1319-26
pubmed: 23249611
PLoS One. 2021 May 13;16(5):e0251645
pubmed: 33984044
AIDS. 2020 Dec 1;34(15):2223-2230
pubmed: 32694412
AIDS. 2014 Mar;28 Suppl 2:S105-18
pubmed: 24849469
BMC Infect Dis. 2019 Mar 15;19(1):261
pubmed: 30876400
AIDS. 2020 Dec 1;34(15):2321-2323
pubmed: 33196496
Clin Infect Dis. 2022 Apr 28;74(8):1350-1359
pubmed: 34309633
PLoS One. 2016 Aug 10;11(8):e0159994
pubmed: 27509182
Health Policy Plan. 2016 Dec;31(10):1342-1354
pubmed: 27375126
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21635
pubmed: 28770591
AIDS Behav. 2018 Jan;22(1):154-163
pubmed: 28849289
BMC Pediatr. 2020 Oct 10;20(1):472
pubmed: 33038931