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Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort

BACKGROUND: The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL)...

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Autores principales: Carmona, Sergio, Bor, Jacob, Nattey, Cornelius, Maughan-Brown, Brendan, Maskew, Mhairi, Fox, Matthew P, Glencross, Deborah K, Ford, Nathan, MacLeod, William B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850436/
https://www.ncbi.nlm.nih.gov/pubmed/29514238
http://dx.doi.org/10.1093/cid/ciy045
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author Carmona, Sergio
Bor, Jacob
Nattey, Cornelius
Maughan-Brown, Brendan
Maskew, Mhairi
Fox, Matthew P
Glencross, Deborah K
Ford, Nathan
MacLeod, William B
author_facet Carmona, Sergio
Bor, Jacob
Nattey, Cornelius
Maughan-Brown, Brendan
Maskew, Mhairi
Fox, Matthew P
Glencross, Deborah K
Ford, Nathan
MacLeod, William B
author_sort Carmona, Sergio
collection PubMed
description BACKGROUND: The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data. METHODS: We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex. RESULTS: 8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease. CONCLUSIONS: The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized.
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spelling pubmed-58504362018-03-23 Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort Carmona, Sergio Bor, Jacob Nattey, Cornelius Maughan-Brown, Brendan Maskew, Mhairi Fox, Matthew P Glencross, Deborah K Ford, Nathan MacLeod, William B Clin Infect Dis Advanced HIV Disease BACKGROUND: The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data. METHODS: We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex. RESULTS: 8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease. CONCLUSIONS: The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized. Oxford University Press 2018-04-01 2018-03-04 /pmc/articles/PMC5850436/ /pubmed/29514238 http://dx.doi.org/10.1093/cid/ciy045 Text en © 2018 World Health Organization; licensee Oxford University Press USA. http://creativecommons.org/licenses/by/3.0/igo/legalcode This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.
spellingShingle Advanced HIV Disease
Carmona, Sergio
Bor, Jacob
Nattey, Cornelius
Maughan-Brown, Brendan
Maskew, Mhairi
Fox, Matthew P
Glencross, Deborah K
Ford, Nathan
MacLeod, William B
Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title_full Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title_fullStr Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title_full_unstemmed Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title_short Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
title_sort persistent high burden of advanced hiv disease among patients seeking care in south africa’s national hiv program: data from a nationwide laboratory cohort
topic Advanced HIV Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850436/
https://www.ncbi.nlm.nih.gov/pubmed/29514238
http://dx.doi.org/10.1093/cid/ciy045
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