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. 2012:2012:293795.
doi: 10.1155/2012/293795. Epub 2012 Apr 24.

Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India

Gerardo Alvarez-Uria  1 , Manoranjan Midde, Raghavakalyan Pakam, Shanmugamari Kannan, Lakshminarayana Bachu, Praveen Kumar Naik
Affiliations

Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India

Gerardo Alvarez-Uria et al. Interdiscip Perspect Infect Dis. 2012.

Abstract

We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count <200 and <350 cells/mm(3) were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm(3), the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries.

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Figures

Figure 1
Figure 1
Reasons for HIV diagnosis in women and men.
Figure 2
Figure 2
Description of CD4 lymphocyte count by reason for HIV testing in descending order from right to left. Boxes represent median and 25–75 percentiles. Whiskers represent 5 and 95 percentiles. *STI: sexually transmitted infection.
Figure 3
Figure 3
Median and interquartile range of CD4 lymphocyte count at HIV presentation by calendar year of presentation.
Figure 4
Figure 4
Cumulative incidence of patients who will require antiretroviral treatment according to three different thresholds for initiating HIV treatment after 0, 6, 12, 18, 24, 30 and 36 months since the first determination of CD4 lymphocyte count. *ART: antiretroviral therapy.
See this image and copyright information in PMC

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