XVIII International AIDS Conference

Abstract

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Late diagnosis of HIV infection results in a higher mortality but not in virological failure after starting HAART

B. Crabtree-Ramírez1, Y. Caro-Vega2, J. Sierra-Madero1

1Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Infectious Diseases, Mexico City, Mexico, 2Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico

Background: Diagnosis of HIV-infection in advanced stages of disease is a major factor that limits the benefits of HAART. The objective of this study was to determine mortality, lost to follow-up (LTFU), and virological failure (VF) after HAART initiation in “late testers” (LT) compared to “non late testers” (NLT) in a clinic cohort from 2001 to 2007.
Methods: All patients from the INCMNSZ HIV Clinic presenting to care with a recent HIV diagnosis (< 6 months) were analyzed. LT were those who had an AIDS-related disease and/or CD4+ cell count < 200/mm3; the rest were NLT. Mortality, LTFU (those missing appointments for >1 year and never returned during the observation period) and VF (any confirmed HIV-1 viral load >50 copies/mL after 6 months on HAART), were compared between groups.
Results: Of 1031 patients, 397 had a recent HIV diagnosis and complete data, for a total of 1463.65 person/years of follow-up (median 3.48 years; IQR 1.61-5.62). 72% were male; median age was 33 years (range 28-40). 234 were LT and 163 NLT; 217 of LT and 131 of NLT initiated HAART during the period observed. Crude mortality rates and retention to the clinic (patients who survived and were not LTFU) were different between groups during the period observed: 2.27 per 100 person-year in LT vs 0.40 in NLT and 68% in LT vs 76% in NLT (p=0.001), respectively. However, VF during the first year on HAART was not different between groups (8.4% in LT vs 6.1% in NLT; p=0.44).
Conclusions: LT is the most common presentation to medical care for HIV infected patients in our center. Crude mortality is significantly higher in LT. Retention to care is shorter in LT, however, VF is not more common in LT who remain in care in the first year after HAART, compared to the group of NLT.


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