Consequences of Late Presentation for HIV Care in Mexico, 2007-2013
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
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).
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.
D. De La Rosa Zamboni,
V. Ahumada Topete, None
A. Murakami, None
E. Lopez, None
C. Albanez, None
G. Reyes Terán, None