title: Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD.
abstract: Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003-2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/μl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31-40, 41-50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31-1.88; OR = 2.01, 95% CI 1.58-2.56; and OR = 1.69, 95% CI 1.23-2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42-3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35-0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36-0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care.
authors.affiliation: 1 Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: 2 University of Malaya Medical Centre , Kuala Lumpur, Malaysia .
authors.forename: Claire
authors.initials: C
authors.lastname: Italiano
authors.affiliation: 3 Research Institute for Health Sciences, Chiang Mai University , Chiang Mai, Thailand .
authors.forename: Romanee
authors.initials: R
authors.lastname: Chaiwarith
authors.affiliation: 4 Department of Infectious Diseases, Tan Tock Seng Hospital , Singapore, Singapore .
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.affiliation: 2 University of Malaya Medical Centre , Kuala Lumpur, Malaysia .
authors.forename: Sasheela
authors.initials: S
authors.lastname: Vanar
authors.affiliation: 5 The Kirby Institute , UNSW Australia, Sydney, Australia .
authors.forename: Awachana
authors.initials: A
authors.lastname: Jiamsakul
authors.affiliation: 6 National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences , Phnom Penh, Cambodia .
authors.forename: Vonthanak
authors.initials: V
authors.lastname: Saphonn
authors.affiliation: 7 National Hospital for Tropical Diseases , Hanoi, Vietnam .
authors.forename: Kinh Van
authors.initials: KV
authors.lastname: Nguyen
authors.affiliation: 8 Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand .
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.affiliation: 9 Queen Elizabeth Hospital , Hong Kong, China .
authors.forename: Man Po
authors.initials: MP
authors.lastname: Lee
authors.affiliation: 10 Faculty of Medicine Udayana University and Sanglah Hospital , Bali, Indonesia .
authors.forename: Tuti Parwati
authors.initials: TP
authors.lastname: Merati
authors.affiliation: 11 Bach Mai Hospital , Hanoi, Vietnam .
authors.forename: Thuy Thanh
authors.initials: TT
authors.lastname: Pham
authors.affiliation: 12 Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital , Jakarta, Indonesia .
authors.forename: Evy
authors.initials: E
authors.lastname: Yunihastuti
authors.affiliation: 13 Research Institute for Tropical Medicine , Manila, Philippines .
authors.forename: Rossana
authors.initials: R
authors.lastname: Ditangco
authors.affiliation: 14 YRGCARE Medical Centre, VHS , Chennai, India .
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: 15 Beijing Ditan Hospital, Capital Medical University , Beijing, China .
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.affiliation: 16 Taipei Veterans General Hospital , Taipei, Taiwan .
authors.forename: Wingwai
authors.initials: W
authors.lastname: Wong
authors.affiliation: 17 Hospital Sungai Buloh , Sungai Buloh, Malaysia .
authors.forename: Benedict L H
authors.initials: BL
authors.lastname: Sim
authors.affiliation: 18 Institute of Infectious Diseases , Pune, India .
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pujari
authors.affiliation: 19 Chiangrai Prachanukroh Hospital , Chiang Rai, Thailand .
authors.forename: Pacharee
authors.initials: P
authors.lastname: Kantipong
authors.affiliation: 20 HIV-NAT/Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.affiliation: 21 Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand .
authors.forename: Winai
authors.initials: W
authors.lastname: Ratanasuwan
authors.affiliation: 22 National Center for Global Health and Medicine , Tokyo, Japan .
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.affiliation: 23 Hospital Raja Perempuan Zainab II , Kota Bharu, Malaysia .
authors.forename: Mahiran
authors.initials: M
authors.lastname: Mustafa
authors.affiliation: 24 TREAT Asia, amfAR-The Foundation for AIDS Research , Bangkok, Thailand .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.affiliation: 1 Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000367:Age Factors; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous