THE CHALLENGE AND CONSEQUENCES OF LATE DIAGNOSIS AND LATE INITIATION OF ART BRENDA CRABTREE MD...
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THE CHALLENGE AND CONSEQUENCES OF LATE DIAGNOSIS AND LATE INITIATION OF ART BRENDA CRABTREE MD HIV/AIDS CLINIC, DEPARTMENT OF INFECTIOUS DISEASES INSTITUTO
THE CHALLENGE AND CONSEQUENCES OF LATE DIAGNOSIS AND LATE
INITIATION OF ART BRENDA CRABTREE MD HIV/AIDS CLINIC, DEPARTMENT OF
INFECTIOUS DISEASES INSTITUTO NACIONAL DE CIENCIAS MDICAS Y
NUTRICIN SALVADOR ZUBIRN MEXICO CITY, MEXICO
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THE CHALLENGE AND CONSEQUENCES OF LATE DIAGNOSIS AND LATE
INITIATION OF ART Poznansky 1995 Subjects who are HIV positive and
present late are a challenge to the control of the spread of HIV
infection Poznansky MC, et al. HIV positive patients first
presenting with an AIDS defining illness: characteristics and
survival. Br Med J 1995. 311, 156158.
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DHHS, March 29, 2012 WHO, April 2012
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WHAT DO WE MEAN BY LATE? MANY DEFINITIONS Fisher M. Curr. Opin.
Infect. Dis 2008. 21, 13. Wong K-H, et al, AIDS Patient Care STDs
2003; 7, 461469. Smith RD, et al, AIDS 2010; 24(13), 21092115.
Fleishman JA, et al, Med. Care 2010; 48(12), 10711079. Waters and
Sabin, Expert Rev Anti Infect Ther. 2011; 9(10), 877-889. Late
testing Subjects who first present:
Late HAART initiation (77%): Late testers (55%): recent
diagnosis ( 6 mo before initiating HAART ) Many of these, were also
late testers PREVALENCE IN LATIN AMERICA AND THE CARIBBEAN
Crabtree-Ramrez, CCASAnet et al; PLOS ONE; May 2011,6(5):
e20272
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Risk factors: Lack of self perception of risk Heterosexuals,
elderly population Vulnerable population Immigrant, IVDU, less
educated, minority populations Social and individual factors Stigma
and discrimination WHO ARE AT RISK OF BEING LATE? McDonald AM, Aust
NZ Public Health 2003; 27:608-13. CDC. MMWR 2003;32:581586. Krentz
HB, HIV Med 2004; 5:938. Nogueda MJ, et al, IAS 2011, Rome, Italy
Abstract CDD203 Crabtree-Ramrez, CCASAnet et al; PLOS ONE;
2011,6(5): e20272 Fisher M. Curr. Opin. Infect. Dis 2008. 21, 13.
Girardi Eet al. J Acquir Immune Syndr 2004; 36:951-9. Brannstrom J,
et al. Int J STD AIDS 2005; 16:702-706. Sullivan AK, BMJ 2005;
330:1301-1302. Delpierre C, et al. Int J STD AIDS 2007; 18:312-317
Castilla J, et al. AIDS 2002; 16:19451951.
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TRENDS ALONG TIME OF LATE PRESENTERS In addition, small
reduction in the prevalence of late presenters along time
1.Lundgren J; el at; COHERE; THAB0303, AIDS 2012 2.Egger, IeDEA,
Paper 100, CROI 2012, Seattle, USA 12
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WHAT ARE THE CONSEQUENCES OF STARTING LATE? Adapted from:
Waters and Sabin, Expert Rev Anti Infect Ther. 2011; 9(10), 877-889
Higher risk of mortality in the 1 st year ART CC and ART LINC,
Lancet 2006; 367: 81724 Reduced chance of viral supression Waters
L, HIV Med 2011 12(5), 289298. Increased risk of hospitalization
Sabin CA, AIDS 2004; 18:21452151 More potential drug-drug
interaction Rockstroh JK, Antivir. Ther 2010.15 (S1), 25-30 More
likely to have IRIS Barber D, Nature Rev 2011 vol 10: 150 Higher
risk of mortality in the 1 st year ART CC and ART LINC, Lancet
2006; 367: 81724 Reduced chance of viral supression Waters L, HIV
Med 2011 12(5), 289298. Increased risk of hospitalization Sabin CA,
AIDS 2004; 18:21452151 More potential drug-drug interaction
Rockstroh JK, Antivir. Ther 2010.15 (S1), 25-30 More likely to have
IRIS Barber D, Nature Rev 2011 vol 10: 150 Increased risk of
non-AIDS events Reekie, AIDS. 2011;25(18):2259-68 Increased risk of
neurocognitive impairment Ellis RJ, AIDS 2011;25(14):1747-51
Potentially increased risk of HIV transmission Cohen MS, N Engl J
Med. 2011;365(6):493-505 Higher direct cost of care RY Chen, et al;
Clin Infect Dis 2006 Increased risk of non-AIDS events Reekie,
AIDS. 2011;25(18):2259-68 Increased risk of neurocognitive
impairment Ellis RJ, AIDS 2011;25(14):1747-51 Potentially increased
risk of HIV transmission Cohen MS, N Engl J Med.
2011;365(6):493-505 Higher direct cost of care RY Chen, et al; Clin
Infect Dis 2006 Short Term Long Term
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Consequences: Mozambique Micek et al JAIDS 2009 23,430 Tested
for HIV 7,005 Tested HIV positive (30%) 1,506 Eligible forART
Initiation (49%) 3,956 Enrolled HIV care