Program Schedule

1133
Consequences of Late Presentation for HIV Care in Mexico, 2007-2013

Session: Poster Abstract Session: Viral Infections: Epidemiology
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • poster IDWeek2014.pdf (1.6 MB)
  • Background:

    In Mexico, there is a limited number of studies describing the characteristics of hospitalized HIV-infected patients and exploring the risk factors for mortality in the era of antiretroviral therapy (ART).

    Methods: 85% of the data were collected from a prospective database and 15% were collected retrospectively. All HIV-infected patients hospitalized from April 2007 to February 2013 were included in the study. Poisson Logistic regression was used

    Results:

    1310 HIV-infected patients were included in the study and 91 were excluded due to incomplete clinical data. Median age was 33 years (interquartile range (IQR) 28-40); 94% were male; and median CD4 T cell count was 54 cells/mm3 (IQR 23-125). 300 patients were receiving ART on admission (21%); 237 died (18%). Hospitalizations were due to opportunistic infections in 1032 patients (79%): 475 had PCP (48%); 94 had TB (19%); 107 had cryptococcosis (10%); 88 had Kaposi's sarcoma (9%); 70 had cytomegalovirus (7%); 66 had Mycobacterium avium complex (6%); 50 had histoplasmosis (5%); and 203 had unidentified acid-fast bacillus (20%). In addition, 277 had bacterial confection (21%); 79 had Hepatitis B (6%); 53 had syphilis (4%); and 30 had Influenza (3%). Median length of hospital stay was 15 days (IQR 9-22). By using univariate analysis, mortality had a negative association with higher CD4 T cell counts (HR 0.7, CI 95% 0.6-0.8, p<0.001); and a positive association with older age (HR 1.2, CI 95% 1.0-1.4, p=0.04). ART use on admission had a weak association with decreased mortality (p=0.06). In the multivariate analysis these factors were not associated with mortality, but renal failure, low platelet counts and respiratory failure remained as risk factors for mortality (HR 1.7, 95% CI 1.1-2.6, p=0.01; HR 1.23, 95% CI 1.06-1.43, p= 0.005; HR 5.6, CI 95% 3.6-8.5, p>0.001 respectively).


    Conclusion:

    80% of the patients were admitted on stage C3 of HIV-infection and 79% were without ART. Mortality was associated with poor clinical condition (renal failure, low platelet counts and respiratory failure). The fact that ART was not protective against mortality was probably due to late presentation for HIV care in most of the patients. Health policies should focus on early presentation for HIV care.

    Daniela De La Rosa Zamboni, MSC1, Maria Gomez Palacio Maria, MD1, Victor Ahumada Topete, MD1, Akio Murakami, MD2, Erika Lopez, MD3, Carmen Albanez3 and Gustavo Reyes Terán, PhD1, (1)Department of Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico, (2)Department of Research in Infectious Siseases, National Institute of Respiratory Diseases, Mexico City, Mexico, (3)Department of Research in Infectious Siseases, National Institute of Respiratory Diseases, mexico City, Mexico

    Disclosures:

    D. De La Rosa Zamboni, None

    M. Gomez Palacio Maria, None

    V. Ahumada Topete, None

    A. Murakami, None

    E. Lopez, None

    C. Albanez, None

    G. Reyes Terán, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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