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

    53 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/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

    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)
    • General

    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/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.",
    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",

    }

    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/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.

    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/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.

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