title: Cross-sectional analysis of late HAART initiation in Latin America and the Caribbean: late testers and late presenters.
abstract: BACKGROUND
  Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI) in this region.
  
  
  METHODS
  Cross-sectional analysis from 9817 HIV-infected treatment-naïve patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico) from October 1999 to July 2010. LHI had CD4(+) count ≤200 cells/mm(3) prior to HAART. Late testers (LT) were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters (LP) initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed.
  
  
  RESULTS
  Among subjects starting HAART (n = 9817) who had baseline CD4(+) available (n = 8515), 76% were LHI: Argentina (56%[95%CI:52-59]), Chile (80%[95%CI:77-82]), Haiti (76%[95%CI:74-77]), Honduras (91%[95%CI:87-94]), Mexico (79%[95%CI:75-83]), Peru (86%[95%CI:84-88]). The proportion of LHI statistically changed over time (except in Honduras) (p≤0.02; Honduras p = 0.7), with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses (CSA). Older patients were more likely LHI in Argentina and Peru (OR 1.21 per +10-year of age, 95%CI:1.02-1.45; OR 1.20, 95%CI:1.02-1.43; respectively), but not in CSA (OR 1.07, 95%CI:0.94-1.21). Higher education was associated with decreased risk for LHI in Chile (OR 0.92 per +1-year of education, 95%CI:0.87-0.98) (similar trends in Mexico, Peru, and CSA). LHI with date of HIV-diagnosis available, 55% were LT and 45% LP.
  
  
  CONCLUSIONS
  LHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation are needed to maximize benefits from HAART in the region.
authors.affiliation: Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, Mexico City, Mexico.
authors.forename: Brenda
authors.initials: B
authors.lastname: Crabtree-Ramírez
authors.forename: Yanink
authors.initials: Y
authors.lastname: Caro-Vega
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Firas
authors.initials: F
authors.lastname: Wehbe
authors.forename: Carina
authors.initials: C
authors.lastname: Cesar
authors.forename: Claudia
authors.initials: C
authors.lastname: Cortés
authors.forename: Denis
authors.initials: D
authors.lastname: Padgett
authors.forename: Serena
authors.initials: S
authors.lastname: Koenig
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.forename: Catherine
authors.initials: C
authors.lastname: McGowan
authors.forename: Daniel
authors.initials: D
authors.lastname: Masys
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D017691:Caribbean Region / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors