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

    55 Scopus citations

    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/mm3 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

    ASJC Scopus subject areas

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

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    Crabtree-Ramírez, B., Caro-Vega, Y., Shepherd, B. E., Wehbe, F., Cesar, C., Cortés, C., Padgett, D., Koenig, S., Gotuzzo, E., Cahn, P., McGowan, C., Masys, D., Sierra-Madero, J., & 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