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Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study
BACKGROUND: Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651303/ https://www.ncbi.nlm.nih.gov/pubmed/23622568 http://dx.doi.org/10.1186/1471-2458-13-397 |
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author | Iwuji, Collins C Churchill, Duncan Gilleece, Yvonne Weiss, Helen A Fisher, Martin |
author_facet | Iwuji, Collins C Churchill, Duncan Gilleece, Yvonne Weiss, Helen A Fisher, Martin |
author_sort | Iwuji, Collins C |
collection | PubMed |
description | BACKGROUND: Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm(3)) and mortality. METHODS: Patients newly diagnosed with HIV infection at a UK clinic were recruited from January 1996 to May 2010. Factors associated with late presentation were assessed using logistic regression. Factors associated with mortality rates were analysed using Poisson regression. RESULTS: Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mm(3) at presentation (“late presentation”). The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual. The mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40). CONCLUSIONS: Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50. |
format | Online Article Text |
id | pubmed-3651303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-36513032013-05-11 Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study Iwuji, Collins C Churchill, Duncan Gilleece, Yvonne Weiss, Helen A Fisher, Martin BMC Public Health Research Article BACKGROUND: Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm(3)) and mortality. METHODS: Patients newly diagnosed with HIV infection at a UK clinic were recruited from January 1996 to May 2010. Factors associated with late presentation were assessed using logistic regression. Factors associated with mortality rates were analysed using Poisson regression. RESULTS: Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mm(3) at presentation (“late presentation”). The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual. The mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40). CONCLUSIONS: Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50. BioMed Central 2013-04-26 /pmc/articles/PMC3651303/ /pubmed/23622568 http://dx.doi.org/10.1186/1471-2458-13-397 Text en Copyright © 2013 Iwuji et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Iwuji, Collins C Churchill, Duncan Gilleece, Yvonne Weiss, Helen A Fisher, Martin Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title | Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title_full | Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title_fullStr | Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title_full_unstemmed | Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title_short | Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study |
title_sort | older hiv-infected individuals present late and have a higher mortality: brighton, uk cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651303/ https://www.ncbi.nlm.nih.gov/pubmed/23622568 http://dx.doi.org/10.1186/1471-2458-13-397 |
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