title: Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India.
abstract: We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count <200 and <350 cells/mm(3) were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm(3), the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries.
authors.affiliation: Department of Infectious Diseases, Rural Development Trust Hospital, Kadiri Road, Bathalapalli 515661, India.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Alvarez-Uria
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Midde
authors.forename: Raghavakalyan
authors.initials: R
authors.lastname: Pakam
authors.forename: Shanmugamari
authors.initials: S
authors.lastname: Kannan
authors.forename: Lakshminarayana
authors.initials: L
authors.lastname: Bachu
authors.forename: Praveen Kumar
authors.initials: PK
authors.lastname: Naik