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

Caro-Vega, Y.N.; Cortes, C.P.; Gotuzzo Herencia, José Eduardo; Pape, J.W.; Sierra-Madero, J.G.; Caribbean, Central and South America network for HIV epidemiology (CCASAnet); Crabtree-Ramírez, B.E.; Belaunzarán-Zamudio, P.F.; Cardoso, S.W.; Mejía Cordero, Fernando Alonso; Shepherd, B.E.; Padgett, D.; Rouzier, V.; Rebeiro, P.F.; Grinsztejn, B.; Veloso, V.; McGowan, C.C.

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.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