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Comparative Study
. 2014;26(12):1514-20.
doi: 10.1080/09540121.2014.938016. Epub 2014 Jul 17.

What's pregnancy got to do with it? Late presentation to HIV/AIDS services in Northeastern Brazil

Inês Dourado  1 , Sarah MacCarthy, Carlos Lima, Maria Amélia Veras, Ligia Kerr, Ana Maria de Brito, Sofia Gruskin
Affiliations
Comparative Study

What's pregnancy got to do with it? Late presentation to HIV/AIDS services in Northeastern Brazil

Inês Dourado et al. AIDS Care. 2014.

Abstract

Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm(3). Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.

Keywords: Brazil; CD4 count; HIV/AIDS; late presentation; pregnancy.

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Conflict of interest statement

Competing interests

None of the authors have any conflicts of interest (including financial and other relationships) to declare.

Figures

Figure 1
Figure 1
Distribution and median CD4 count for pregnant women (543 cells per mm3), non-pregnant women (307 cells per mm3) and men (298 cells per mm3)
See this image and copyright information in PMC

References

    1. Adler A, Mounier-Jack S, Coker RJ. Late diagnosis of HIV in Europe: definitional and public health challenges. [Research Support, Non-U.S. Gov’t] AIDS Care. 2009;21(3):284–293. doi: 10.1080/09540120802183537. - DOI - PubMed
    1. Althoff KN, Gange SJ, Klein MB, Brooks JT, Hogg RS, Bosch RJ, Moore RD. Late presentation for human immunodeficiency virus care in the United States and Canada. Clin Infect Dis. 2010;50(11):1512–1520. doi: 10.1086/652650. - DOI - PMC - PubMed
    1. Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, De Wolf F. Late presentation of HIV infection: a consensus definition. [Research Support, Non-U.S. Gov’t] HIV Med. 2011;12(1):61–64. doi: 10.1111/j.1468-1293.2010.00857.x. - DOI - PubMed
    1. Antinori A, Johnson M, Moreno S, Yazdanpanah Y, Rockstroh JK. Report of a European Working Group on late presentation with HIV infection: recommendations and regional variation. [Congresses Research Support, Non-U.S. Gov’t] Antivir Ther. 2010;15(Suppl 1):31–35. doi: 10.3851/IMP1525. - DOI - PubMed
    1. Bamford LP, Ehrenkranz PD, Eberhart MG, Shpaner M, Brady KA. Factors associated with delayed entry into primary HIV medical care after HIV diagnosis. AIDS. 2010;24(6):928–930. doi: 10.1097/QAD.0b013e328337b116. - DOI - PubMed

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