of HIV Infection James Hand Clinical Nurse Manager for HIV amp Hepatitis Research Barts Health NHS Trust Definitions Late presentation Persons presenting for care with a CD4 lt ID: 372161
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Slide1
Late Presentation of HIV Infection
James Hand
Clinical Nurse Manager for HIV & Hepatitis Research
Barts
Health NHS TrustSlide2
Definitions
Late
presentation:
Persons presenting
for care with a
CD4
<
350/mm3
cells
or presenting with an AIDS-defining event, regardless of the
CD4. Slide3
Definitions
Presentation
with advanced HIV disease:
Persons presenting
for care with a CD4
<200/mm3
or
presenting with an AIDS-defining event, regardless of the
CD4.Slide4
In 2012 Half of these cases of HIV were reported as late presenters (LP) (CD4 <350/mm3)
30% of
late presenters
had advanced HIV infection (CD4 <200/mm3)
Late diagnosis in EuropeSlide5
COHERE study
Late presentation was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis.
Late presentation or very late presentation significantly increased the risk of AIDS/death in the first two years after entry into HIV
care
Mocroft
A et al.
Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe
Study
(COHERE).
PLOS Medicine: 10:9, e1001510, 2013. Slide6
Europe
Rate of late presentation are declining in MSM.
People over 50 are more likely to present late in infection.
Immigrants more likely to be late presenters.
Hofstra
M et al. Late presentation of HIV infection in Europe. 14th European AIDS Conference, Brussels, abstract LBPS8/3, 2013. Slide7
Why do people present
late?
Stigma
Fear
Ignorance
Lack of availability of testingSlide8
How can we reduce late presentation
?
Increase HIV testing
Universal Opt out testing
Increasing HIV Knowledge
Reducing Stigma
What is feasible with limited resources?Slide9