title: Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort.
abstract: BACKGROUND
  Late diagnosis of human immunodeficiency virus (HIV) infection remains common despite advances in therapy and prognosis. The southeastern United States is a rapidly growing Latino settlement area where ethnic disparities may contribute to late presentation to care.
  
  
  METHODS
  We assessed demographic and clinical factors between racial/ethnic groups at the time of HIV care initiation in the University of North Carolina Center for AIDS Research Clinical Cohort. We identified independent predictors of late presentation, defined as a CD4(+) T lymphocyte (CD4) count <350 cells/mm(3) or an AIDS-defining event (ADE), using log-linear binomial regression.
  
  
  RESULTS
  During the period 1999-2009, 853 patients initiated HIV care, of whom 11% were Latino, 28% were white, and 61% were black. Median initial CD4 counts were lower for Latino patients (186 cells/mm(3)) than white patients (292 cells/mm(3); P = .006) and black patients (302 cells/mm(3); P = .02). Latino persons were more likely to be late presenters than white or black persons (76% vs 58%; P < .001) and accounted for 86%, 75%, and 50% of all presenting cases of active tuberculosis, histoplasmosis, and toxoplasmosis, respectively. Latino ethnicity, older age, male sex, and earlier entry year were independently associated with late presentation (P < .05 for all). In multivariable analyses, Latino persons were 1.29 times more likely to present to care late than white or black persons (95% confidence interval, 1.15-1.45).
  
  
  CONCLUSIONS
  Latinos are more likely to initiate HIV care later in the course of illness than are black and white persons and account for a majority of several ADEs. Strategies to improve earlier HIV testing among Latinos in new settlement areas are needed.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7030, USA. adennis@med.unc.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dennis
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Seña
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000208:ethnology; D000328:Adult; D001741:Black or African American; D000375:Aging; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015144:Southeastern United States / Q000453:epidemiology; D013997:Time Factors; D044465:White People; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents