title: Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010.
abstract: BACKGROUND
  Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated.
  
  
  METHODS
  A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm(3) or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm(3) or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods.
  
  
  RESULTS
  Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm(3) (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD.
  
  
  CONCLUSIONS
  The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed.
authors.affiliation: Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Voluntary Counseling and Testing Site/Specialized Center in HIV Outclinic Patients Care (CTA-SAE), Belo Horizonte, MG, Brazil. Electronic address: melissabv@hotmail.com.
authors.forename: Melissa Bianchetti
authors.initials: MB
authors.lastname: Valentini
authors.affiliation: National School of Statistical Science-Instituto Brasileiro de Geografia e Estatística (IBGE), Rio de Janeiro, RJ, Brazil.
authors.forename: Maria Luíza Guerra de
authors.initials: ML
authors.lastname: Toledo
authors.affiliation: Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Marise Oliveira
authors.initials: MO
authors.lastname: Fonseca
authors.affiliation: Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Laura Maria Silva
authors.initials: LM
authors.lastname: Thiersch
authors.affiliation: Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Ingrid Silva Bremer de
authors.initials: IS
authors.lastname: Toledo
authors.affiliation: Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Flávia Cristina Jácome
authors.initials: FC
authors.lastname: Machado
authors.affiliation: Postgraduate Program on Health Science, Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Unaí
authors.initials: U
authors.lastname: Tupinambás
mesh_terms: D000328:Adult; D001938:Brazil; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D019562:Viral Load
keywords: AIDS; CD4 cell count; HIV infection; Late presentation