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Long‐term trends in HIV care entry: over 15 years of clinical experience from Poland
Author(s) -
Siwak E,
Horban A,
WitakJędra M,
Cielniak I,
FirlągBurkacka E,
LeszczyszynPynka M,
Witor A,
Muller K,
BociągaJasik M,
KalinowskaNowak A,
Gąsiorowski J,
Szetela B,
Jabłonowska E,
WójcikCichy K,
Jankowska J,
Lemańska M,
Olczak A,
Grąbczewska E,
Grzeszczuk A,
RogalskaPlonska M,
Suchacz M,
Mikuła T,
Łojewski W,
Bielec D,
Kocbach P,
Błudzin W,
Parczewski M
Publication year - 2019
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12762
Subject(s) - medicine , confidence interval , odds ratio , human immunodeficiency virus (hiv) , disease , transmission (telecommunications) , pediatrics , immunology , electrical engineering , engineering
Delay in HIV diagnosis and consequently late care entry with low CD 4 counts remain a major challenge for the control of the HIV / AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. Methods Cross‐sectional data were collected for 3972 HIV ‐infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000–2015. Clinical data were analysed and factors associated with late presentation (baseline CD 4 count < 350 cells/μL or history of AIDS ‐defining illness) and advanced HIV disease (baseline CD 4 count < 200 cells/μL or history of AIDS ) were identified. Results The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval ( CI ) 1.46–4.47] for late presentation and 3.13 (95% CI 1.49–6.58) for advanced disease for the 21–30‐year‐old category to 5.2 (95% CI 1.94–14.04) and 8.15 (95% CI 2.88–23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio ( aOR ) 1.74 (95% CI 1.16–2.60) and 1.55 (95% CI 1.05–2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [ aOR 0.3 (95% CI 0.31–0.59) and 0.39 (95% CI 0.29–0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) ( P < 0.0001) and from 43.5% (2000) to 28.4% (2015) ( P = 0.001), respectively. Conclusions Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.