Sociobehavioral Risk Factors and Clinical Implications of Late Presentation Among People Living with HIV in the Brazilian Amazon Region

• Published in: AIDS and behavior Vol. 28; no. 10; pp. 3404 - 3420
• Main Authors: Pereira, Leonn Mendes Soares, França, Eliane dos Santos, Costa, Iran Barros, Lima, Igor Tenório, Freire, Amaury Bentes Cunha, Ramos, Francisco Lúzio de Paula, Monteiro, Talita Antonia Furtado, Macedo, Olinda, Sousa, Rita Catarina Medeiros, Freitas, Felipe Bonfim, Costa, Igor Brasil, Vallinoto, Antonio Carlos Rosário
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2024; Springer Nature B.V
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Brazil - epidemiology; CD4 Lymphocyte Count; Coinfection - epidemiology; Cross-Sectional Studies; Delayed Diagnosis; Diagnosis; Drinking behavior; Drug abuse; Drug therapy; Female; Flow cytometry; Health Psychology; Health services; Helper cells; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; Homosexuality; Human immunodeficiency virus; Humans; Infectious Diseases; Life expectancy; Life span; Lymphocytes; Lymphocytes T; Male; Medical diagnosis; Medical records; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Polyamory; Prescription drugs; Prevalence; Public Health; Regions; Risk Factors; Sexual Behavior; Sexually transmitted diseases; STD; Substance abuse; Therapy; Tuberculosis; Viral Load; Brazil; Amazon Basin; Brazil; HIV; Amazon; Risk factors; Late presentation
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-024-04437-5

This study aimed to analyze the prevalence, sociobehavioral factors and clinical-laboratory consequences of late presentation among people living with HIV (PLHIV) in the Brazilian Amazon region. In total, 402 HIV + individuals treated at reference units in Belém city (Pará, Brazil) between 2018 and 2019 were evaluated. Late presentation was defined as a first-collection LTCD4 + count below 350 cells/µL. Sociodemographic, behavioral and clinical data were obtained from questionnaires or medical records. Th1, Th2 and Th17 cytokine profiles were evaluated by flow cytometry. Longitudinal data on viral load, T lymphocytes, and antiretroviral therapy administration were obtained from control and logistic databases. Approximately 52.73% of the participants were late presenters and sought medical care 7–12 + months after their primary HIV diagnosis. Sociobehavioral factors associated with late presentation included illicit drug use for more than 5 years, polyamory, no alcohol consumption, homosexuality, and sexual inactiveness after HIV diagnosis. Clinically, late presentation was associated with coinfection rate; polysymptomatology; high IFN-ɣ, IL-6 and IL-10 levels; nonresponse to antiretroviral therapy; and virological failure- and tuberculosis coinfection-motivated changes to therapy. In summary, the prevalence of late presentation in Pará in the Brazilian Amazon region is high. Delays in seeking specialized care after a primary HIV diagnosis cause medium/long-term changes in the life expectancy and health of PLHIV.