Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean

Late testers and late presenters

Brenda Crabtree-Ramírez, Yanink Caro-Vega, Bryan E. Shepherd, Firas Wehbe, Carina Cesar, Claudia Cortés, Denis Padgett, Serena Koenig, Eduardo Gotuzzo, Pedro Cahn, Catherine McGowan, Daniel Masys, Juan Sierra-Madero*, CCASAnet Team The CCASAnet Team

*Corresponding author for this work

Research output: Contribution to journalArticle

52 Citations (Scopus)

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. Methodology: 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 ≤200cells/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. Principal Findings: 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. Conclusion: 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.

Original languageEnglish (US)
Article numbere20272
JournalPloS one
Volume6
Issue number5
DOIs
StatePublished - May 31 2011

Fingerprint

Latin America
Highly Active Antiretroviral Therapy
cross-sectional studies
Peru
Haiti
Cross-Sectional Studies
Honduras
Chile
risk factors
Argentina
Mexico
Education
Patient treatment
higher education
HIV
risk reduction
Developing countries
developing countries
education
CD4 Lymphocyte Count

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Crabtree-Ramírez, B., Caro-Vega, Y., Shepherd, B. E., Wehbe, F., Cesar, C., Cortés, C., ... The CCASAnet Team, CCASA. T. (2011). Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean: Late testers and late presenters. PloS one, 6(5), [e20272]. https://doi.org/10.1371/journal.pone.0020272
Crabtree-Ramírez, Brenda ; Caro-Vega, Yanink ; Shepherd, Bryan E. ; Wehbe, Firas ; Cesar, Carina ; Cortés, Claudia ; Padgett, Denis ; Koenig, Serena ; Gotuzzo, Eduardo ; Cahn, Pedro ; McGowan, Catherine ; Masys, Daniel ; Sierra-Madero, Juan ; The CCASAnet Team, CCASAnet Team. / Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean : Late testers and late presenters. In: PloS one. 2011 ; Vol. 6, No. 5.
@article{9b78af2885a6409f83f0f88c98c7f43f,
title = "Cross-sectional analysis of late HARRT 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. Methodology: Cross-sectional analysis from 9817 HIV-infected treatment-na{\"i}ve patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico) from October 1999 to July 2010. LHI had CD4 + count ≤200cells/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. Principal Findings: 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. Conclusion: 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.",
author = "Brenda Crabtree-Ram{\'i}rez and Yanink Caro-Vega and Shepherd, {Bryan E.} and Firas Wehbe and Carina Cesar and Claudia Cort{\'e}s and Denis Padgett and Serena Koenig and Eduardo Gotuzzo and Pedro Cahn and Catherine McGowan and Daniel Masys and Juan Sierra-Madero and {The CCASAnet Team}, {CCASAnet Team}",
year = "2011",
month = "5",
day = "31",
doi = "10.1371/journal.pone.0020272",
language = "English (US)",
volume = "6",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

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Crabtree-Ramírez, B, Caro-Vega, Y, Shepherd, BE, Wehbe, F, Cesar, C, Cortés, C, Padgett, D, Koenig, S, Gotuzzo, E, Cahn, P, McGowan, C, Masys, D, Sierra-Madero, J & The CCASAnet Team, CCASAT 2011, 'Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean: Late testers and late presenters', PloS one, vol. 6, no. 5, e20272. https://doi.org/10.1371/journal.pone.0020272

Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean : Late testers and late presenters. / Crabtree-Ramírez, Brenda; Caro-Vega, Yanink; Shepherd, Bryan E.; Wehbe, Firas; Cesar, Carina; Cortés, Claudia; Padgett, Denis; Koenig, Serena; Gotuzzo, Eduardo; Cahn, Pedro; McGowan, Catherine; Masys, Daniel; Sierra-Madero, Juan; The CCASAnet Team, CCASAnet Team.

In: PloS one, Vol. 6, No. 5, e20272, 31.05.2011.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cross-sectional analysis of late HARRT initiation in Latin America and the Caribbean

T2 - Late testers and late presenters

AU - Crabtree-Ramírez, Brenda

AU - Caro-Vega, Yanink

AU - Shepherd, Bryan E.

AU - Wehbe, Firas

AU - Cesar, Carina

AU - Cortés, Claudia

AU - Padgett, Denis

AU - Koenig, Serena

AU - Gotuzzo, Eduardo

AU - Cahn, Pedro

AU - McGowan, Catherine

AU - Masys, Daniel

AU - Sierra-Madero, Juan

AU - The CCASAnet Team, CCASAnet Team

PY - 2011/5/31

Y1 - 2011/5/31

N2 - 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. Methodology: 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 ≤200cells/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. Principal Findings: 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. Conclusion: 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.

AB - 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. Methodology: 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 ≤200cells/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. Principal Findings: 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. Conclusion: 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.

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