Universidad Peruana Cayetano Heredia

The population impact of late presentation with advanced HIV disease and delayed antiretroviral therapy in adults receiving HIV care in Latin America

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dc.contributor.author Belaunzarán-Zamudio, P.F.
dc.contributor.author Caro-Vega, Y.N.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Rebeiro, P.F.
dc.contributor.author Crabtree-Ramírez, B.E.
dc.contributor.author Cortes, C.P.
dc.contributor.author Grinsztejn, B.
dc.contributor.author Gotuzzo Herencia, José Eduardo
dc.contributor.author Mejía Cordero, Fernando Alonso
dc.contributor.author Padgett, D.
dc.contributor.author Pape, J.W.
dc.contributor.author Rouzier, V.
dc.contributor.author Veloso, V.
dc.contributor.author Cardoso, S.W.
dc.contributor.author McGowan, C.C.
dc.contributor.author Sierra-Madero, J.G.
dc.contributor.author Caribbean, Central and South America network for HIV epidemiology (CCASAnet)
dc.date.accessioned 2020-12-14T16:06:06Z
dc.date.available 2020-12-14T16:06:06Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8664
dc.description.abstract Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001-2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of <200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America. © The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartofseries American Journal of Epidemiology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject acquired immune deficiency syndrome en_US
dc.subject adult en_US
dc.subject early diagnosis en_US
dc.subject HIV infection en_US
dc.subject Latin America en_US
dc.subject retrospective studies en_US
dc.title The population impact of late presentation with advanced HIV disease and delayed antiretroviral therapy in adults receiving HIV care in Latin America en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/aje/kwz252
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.09
dc.relation.issn 1476-6256


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