High prevalence and excess mortality of late presenters among HIV-1, HIV-2 and HIV-1/2 dually infected patients in Guinea-Bissau - a cohort study from West Africa

  • Bo Langhoff Hønge
  • Sanne Jespersen
  • Johanna Aunsborg
  • Delfim Vicente Mendes
  • Candida Medina
  • David da Silva Té
  • Alex Lund Laursen
  • Christian Erikstrup
  • Christian Wejse
  • The Bissau HIV cohort Study group

Abstract

Introduction: HIV infected individuals with late presentation (LP) and advanced disease (AD) have been associated with higher mortality, higher cost of medical management, impaired CD4 cell count increment and potentially ongoing risk of HIV transmission. Here we describe the proportion of patients with LP and AD at an HIV clinic in Guinea-Bissau, identify risk factors and evaluate the outcome of these patients. Methods: we included all patients >15 years diagnosed with HIV-1 and/or HIV-2 at the outpatient HIV clinic at Hospital National Simão Mendes, during June 2005 - December 2013 in a retrospective cohort study. Patients were followed until December 2014. LP and AD was defined as a baseline CD4 cell count of 200-349 cells/µL and <200 cells/µL, respectively. Results: a total of 3,720/5,562 (65.7%) patients had a CD4 cell count measured within the first 90 days of HIV diagnosis. Forty-eight percent had AD and 23% had LP. Risk factors for presentation with AD were male sex, age >30 years, Fula and Mandinga ethnicity. HIV-2 and HIV-1/2 dually infected patients had lower risk of AD compared with HIV-1 infected patients. Although antiretroviral therapy (ART) was initiated for 64.4% of patients, those with AD progression had a 3.82 times higher mortality compared to patients with non-LP. Conclusion: the majority of HIV infected patients presented late. Most of the late-presenters had advanced disease and patients with advanced disease had a very high mortality. Initiatives to enroll patients in care at an earlier point are needed and should focus on risk groups.

The Pan African Medical Journal 2016;25

Author Biographies

Bo Langhoff Hønge
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Denmark; Department of Clinical Immunology, Aarhus University Hospital, Denmark
Sanne Jespersen
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Denmark
Johanna Aunsborg
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Denmark
Delfim Vicente Mendes
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
Candida Medina
National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
David da Silva Té
National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
Alex Lund Laursen
Department of Infectious Diseases, Aarhus University Hospital, Denmark
Christian Erikstrup
Department of Clinical Immunology, Aarhus University Hospital, Denmark
Christian Wejse
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Denmark; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Denmark
The Bissau HIV cohort Study group
GloHAU, Center for Global Health, School of Public Health, Aarhus University, Denmark
Published
2016-10-06
Section
Articles

Journal Identifiers


eISSN: 1937-8688