(Press-News.org) Late diagnosis of HIV infection and entry into care remains a substantial problem across Europe according to a study published in this week's PLOS Medicine. The study, which was an international collaboration led by Amanda Mocroft from University College London, UK, analysed data from the COHERE in EuroCOORD study, an international collaboration including over 84,000 individuals with HIV infections from 35 European countries from January 2000 to January 2011.
The researchers analysed data from over 20 observational studies from across Europe that contribute data to the COHERE collaboration and found that nearly 54% of the participants diagnosed with HIV presented late to a clinic, that is they had a CD4 count of less than 350 cells/mm3 (a measure of white blood cells used to monitor HIV infection) or an AIDS-defining illness within 6 months of HIV diagnosis within the time period studied.
Diagnosis of HIV infection and receiving care as soon as possible after becoming infected with HIV is important for patients because individuals who receive anti-retroviral drugs, which can control but not cure HIV, and counselling earlier have better health outcomes. Individuals who are receiving treatment that reduces the amount HIV virus in their system are also less likely to pass on the virus.
Although researchers found that late presentation overall decreased from 57.3% in 2000 to 51.7% in 2010/11, in some populations, such as injection drug users in Southern Europe, late presentation increased. Late presentation was found to be associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, although this also varied across Europe. They also found that less than 10% of individuals had delayed entry into care after diagnosis, although this information was only available for a minority of patients.
The authors note, "while late presentation has decreased over time across Europe, it remains a significant issue across the European continent with implications for both individuals and the public health in most European regions."
The authors conclude, "[i]t is important that earlier HIV testing strategies are targeted to all populations at risk both within the health care system and in community based programs, to ensure timely referrals after testing positive, improved retention in care strategies, and optimal clinical management and initiation of ART in those testing HIV positive."
###
Funding: The COHERE study group has received generic funding from Agence Nationale de Recherches sur le SIDA et les He´patites Virales (ANRS), France; HIV Monitoring Foundation, The Netherlands; and the Augustinus Foundation, Denmark. COHERE receives funding from the European Union Seventh Framework Programme (FP7/2007–2013) under EuroCoord grant agreement nu 260694. A list of the funders of the participating cohorts can be found on the COHERE website at http://www.cohere.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: AM has received lecture fees, honoraria, and/or consultancies from Pfizer, BI, BMS, Merck, and Gilead. Ad'A is an advisory board member of BMS, Jannsen, Gilead, and ViiV. GF has received honoraria for lectures and advisory boards from Abbott, Bristol-Myers Squibb, Gilead, Janssen-Cilag, and Merck Sharp & Dohme. Research grant to GF from the German Federal Ministry of Education and Research (BMBF) 01KI1017. AJ is a Governor of the Wellcome Trust, a charitable research funding body; in 2011 was a specialist adviser to House of Lords Select Committee on HIV/AIDS; is a member of the UK Expert Advisory Group on AIDS; receives research grant funding from the UK Medical Research Council, Wellcome Trust, UK National Institute for Health Research, and Department of Health. CL has received these research grants: ANRS CMIT soutien (Aproco-Copilote ANRS CO08 HIV cohort, 1997–2012); IMMI (Cohort Fluco A(H1N1) pandemic influenza, 2009–2012); Ministe`re de la Sante´ PHRC (Bivir influenza trial, Oseltamivir Zanamivir, 2006–2012). CS has received funding for Advisory Board membership, speaker panels, and provision of educational materials for Gilead Sciences, Abbott Pharmaceuticals, ViiV, Merck Sharp & Dohme, Janssen-Cilag, and Bristol-Myers Squibb. CT has received honoraria to act as speaker at CME conferences on antiretroviral therapy and HIV disease management from several companies producing antiretroviral drugs, received travel grants to participate in scientific conferences, and acted as scientific consultant for the same companies. GC has had scientific responsibilities in projects receiving specific grant support from the French Agency for Research on AIDS and Viral Hepatitis (ANRS), the European Commission (Framework Program 7), UK Medical Research Council, US National Institute of Health (NIH), Fondation Plan Alzheimer, Gilead, Tibotec, Boehringer Ingelheim, GlaxoSmithKline, Roche, Pfizer, Merck, Abbott, Bristol-Myers Squibb, Janssen, ViiV Healthcare – these grants are managed through her Institution or a non-profit society. GC also serves as Academic Editor on PLOS ONE and is on the editorial board of the BMC Infectious Diseases Journal. OK has received honoraria, consultancy, lecture fees, and travel grants from Abbott Laboratories, Bristol Myers Squibb, Gilead Sciences, Janssen, Merck Sharp & Dohme, Roche, and ViiV Healthcare, and has served/is serving on Advisory Boards for Gilead Sciences, Merck Sharp & Dohme, and ViiV Healthcare. No other competing interests have been declared.
Citation: Mocroft A, Lundgren JD, Sabin ML, Monforte Ad, Brockmeyer N, et al. (2013) Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med 10(9): e1001510. doi:10.1371/ journal.pmed.1001510
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001510
Contact:
Amanda Mocroft
University College London Medical School
UNITED KINGDOM
+44 1730 890194 or +44 2077940500 ext 33194
a.mocroft@ucl.ac.uk
Efforts to ensure earlier diagnosis of HIV infection across Europe are still needed
2013-09-04
ELSE PRESS RELEASES FROM THIS DATE:
Roll-out of community voluntary male circumcision is linked to reduced HIV infection levels
2013-09-04
Roll-out of voluntary male circumcision services into the community of Orange Farm, South Africa is linked to substantial reductions in HIV infection levels, according to a study published in this week's PLOS Medicine. The study, (ANRS-12126), conducted by Bertran Auvert and colleagues from the University of Versailles (France), also reported that substantial uptake of voluntary male circumcision in one community was not linked to changes in sexual behavior that might affect HIV infection rates.
In this study, Bertran Auvert and colleagues estimated HIV infection levels ...
Electromagnets guide heart device implantation, reduce radiation exposure
2013-09-04
Heart failure patients and others who need implanted cardiac devices to help their heart beat regularly may benefit from a new technology to guide their implantation procedure. It uses electromagnets, which work like a GPS tracking system, instead of radiation-based imaging, researchers reported in the American Heart Association journal Circulation: Arrhythmia and Electrophysiology.
Electromagnetic tracking technology was used successfully to implant Cardiac Resynchronization Therapy (CRT) devices in heart failure patients, and substantially cut patients' and doctors' ...
Uncontrolled hypertension is common, but untreated, worldwide
2013-09-04
Hamilton, ON (September 3, 2013) - A global study has found that many patients don't know they have hypertension and, even if they do, too few are receiving adequate drug therapy for their hypertension.
This is true in high income countries, like Canada, as well as middle and low income countries, say an international team of researchers led by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.
The report, which was published today by JAMA, the journal of the American Medical Association, is part of the PURE (Prospective ...
Iranian telegraph operator, first to propose earthquake early warning system
2013-09-04
SAN FRANCISCO -- In 1909, an Iranian telegraph operator living in the remote desert town of Kerman noticed an unusual movement of the magnetic needle of his telegraph instrument. While other telegraph operators during the late 1800s and early 1900s noticed the phenomenon, the Iranian telegraph operator proposed an earthquake early warning system, as detailed in an article published today by the journal Seismological Research Letters (SRL).
Nineteenth century telegraph operators in New Zealand, Switzerland, Chile, the Caribbean and elsewhere noted the usefulness of electric ...
Single combination pill provides benefit to patients with or at risk of CVD
2013-09-04
In a randomized trial that included about 2,000 patients with or at high risk of cardiovascular disease (CVD), use of a fixed-dose combination medication for blood pressure, cholesterol, and platelet control compared to usual care resulted in significantly improved medication adherence after 15 months and small improvements in systolic blood pressure and low-density lipoprotein cholesterol, according to a study in the September 4 issue of JAMA.
"The long-term use of cardiovascular disease preventive therapy is low among people with established disease. This shortfall ...
Multinational study shows need for substantial improvement in hypertension diagnosis and treatment
2013-09-04
In a study that included more than 140,000 participants from17 countries of varying income levels, researchers found a large gap between both detection and control of hypertension across all countries studied, with just over half of participants with hypertension aware of their diagnosis, and about one-third of those being treated for hypertension successfully controlling their blood pressure, according to a study in the September 4 issue of JAMA.
"High blood pressure is the leading cause of cardiovascular disease (CVD) and deaths globally. It is associated with at least ...
Study evaluates prevalence of diabetes among adults in China
2013-09-04
A study based on a nationally representative sample of adults in China in 2010 indicates that nearly 12 percent of Chinese adults had diabetes and the prevalence of prediabetes was about 50 percent, according to a study in the September 4 issue of JAMA.
"Noncommunicable chronic diseases have become the leading causes of mortality and disease burden worldwide. It was estimated that 34.5 million deaths globally were due to noncommunicable diseases in 2010, which reflected a significant increase from 1990. Mortality from diabetes doubled during this period and increased ...
Comparison of antibody levels for 4 different immunization schedules for PCVs
2013-09-04
The use of 4 different 13-valent pneumococcal conjugate vaccine immunization schedules in healthy term infants resulted in no statistically significant differences in antibody levels between the infants after the booster dose at 12 months of age for almost all serotypes, according to a study in the September 4 issue of JAMA.
"The World Health Organization (WHO) estimated that more than 800,000 children younger than 5 years died from pneumococcal disease in 2000, making it the leading vaccine-preventable cause of death. Since the licensure in 2000 of the first 7-valent ...
Effect of iron supplementation among children living in malaria-endemic area on incidence of malaria
2013-09-04
Children in a malaria-endemic community in Ghana who received a micronutrient powder with iron did not have an increased incidence of malaria, according to a study in the September 4 issue of JAMA. Previous research has suggested that iron supplementation for children with iron deficiency in malaria-endemic areas may increase the risk of malaria.
"In sub-Saharan Africa, malaria is a leading cause of childhood morbidity and mortality, and iron deficiency is among the most prevalent preventable nutritional deficiencies. The provision of iron to children with iron deficiency ...
Hepatitis B immunization program in Taiwan associated with reduction in chronic liver disease deaths
2013-09-04
"Hepatitis B virus (HBV) infection causes infant fulminant hepatitis (IFH), and chronic HBV infection may progress to chronic liver disease (CLD) and hepatocellular carcinoma (HCC). Taiwan launched a nationwide HBV immunization program for newborns in July 1984, which has successfully lowered the prevalence of chronic HBV carriers, incidence of HCC, and mortality of IFH in vaccinated birth cohorts. The mortality of CLD before and after HBV immunization has never been examined," write Chun-Ju Chiang, Ph.D., of National Taiwan University, Taipei, and colleagues.
As reported ...