E Siwak1, A Horban1,2, M Witak-Jędra3, I Cielniak1, E Firląg-Burkacka1, M Leszczyszyn-Pynka3, A Witor4, K Muller4, M Bociąga-Jasik5, A Kalinowska-Nowak5, J Gąsiorowski6, B Szetela6, E Jabłonowska7, K Wójcik-Cichy7, J Jankowska8, M Lemańska8, A Olczak9, E Grąbczewska9, A Grzeszczuk10, M Rogalska-Plonska10, M Suchacz11, T Mikuła11, W Łojewski12, D Bielec13, P Kocbach14, W Błudzin15, M Parczewski3. 1. Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland. 2. Department for Adults Infectious Diseases, Medical University of Warsaw, Warsaw, Poland. 3. Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland. 4. Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland. 5. Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland. 6. Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland. 7. Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland. 8. Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, HIV Outpatient Clinic, Gdańsk, Poland. 9. Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland. 10. Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland. 11. Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland. 12. Department of Infectious Diseases, Regional Hospital in Zielona Góra, Zielona Góra, Poland. 13. Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland. 14. Clinical Ward of Infectious Diseases, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland. 15. Department of Infectious Diseases, Regional Hospital in Opole, Opole, Poland.
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.
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-infectedpatients 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.