Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort

Abstract

Background: Late diagnosis of human immunodeficiency virus (HIV) infection remains common despite advances in therapy and prognosis. The southeastern United States is a rapidly growing Latino settlement area where ethnic disparities may contribute to late presentation to care.

Methods: We assessed demographic and clinical factors between racial/ethnic groups at the time of HIV care initiation in the University of North Carolina Center for AIDS Research Clinical Cohort. We identified independent predictors of late presentation, defined as a CD4(+) T lymphocyte (CD4) count <350 cells/mm(3) or an AIDS-defining event (ADE), using log-linear binomial regression.

Results: During the period 1999-2009, 853 patients initiated HIV care, of whom 11% were Latino, 28% were white, and 61% were black. Median initial CD4 counts were lower for Latino patients (186 cells/mm(3)) than white patients (292 cells/mm(3); P = .006) and black patients (302 cells/mm(3); P = .02). Latino persons were more likely to be late presenters than white or black persons (76% vs 58%; P < .001) and accounted for 86%, 75%, and 50% of all presenting cases of active tuberculosis, histoplasmosis, and toxoplasmosis, respectively. Latino ethnicity, older age, male sex, and earlier entry year were independently associated with late presentation (P < .05 for all). In multivariable analyses, Latino persons were 1.29 times more likely to present to care late than white or black persons (95% confidence interval, 1.15-1.45).

Conclusions: Latinos are more likely to initiate HIV care later in the course of illness than are black and white persons and account for a majority of several ADEs. Strategies to improve earlier HIV testing among Latinos in new settlement areas are needed.

Figure 1.

Proportion of patients by race/ethnicity presenting with CD4⁺ cell counts <350 cells/mm³ by time period entering care. Categorized by CD4⁺ cell count distribution.

Figure 2.

AIDS-defining events diagnosed at presentation to care by race/ethnicity. Figure represents total number of cases and overall prevalence (%) within each race/ethnicity. *Other conditions include coccidioidomycosis (n = 1), chronic cryptosporidiosis (n = 3), chronic herpes simplex ulcers (n = 1), recurrent pneumonia (n = 1), progressive multifocal leukoencephalopathy (n = 3), and recurrent Salmonella septicemia (n = 1).