Long‐term trends in HIV care entry: over 15 years of clinical experience from Poland

• Published in: HIV medicine Vol. 20; no. 9; pp. 581 - 590
• Main Authors: Siwak, E, Horban, A, Witak‐Jędra, M, Cielniak, I, Firląg‐Burkacka, E, Leszczyszyn‐Pynka, M, Witor, A, Muller, K, Bociąga‐Jasik, M, Kalinowska‐Nowak, A, Gąsiorowski, J, Szetela, B, Jabłonowska, E, Wójcik‐Cichy, K, Jankowska, J, Lemańska, M, Olczak, A, Grąbczewska, E, Grzeszczuk, A, Rogalska‐Plonska, M, Suchacz, M, Mikuła, T, Łojewski, W, Bielec, D, Kocbach, P, Błudzin, W, Parczewski, M
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2019
• Subjects: Acquired immune deficiency syndrome; AIDS; CD4 antigen; Confidence intervals; Disease control; Drug abuse; Epidemics; HIV; Human immunodeficiency virus; late care entry; late presenters; Patients; Sexually transmitted diseases; STD; time trends; Poland; time trends; late presenters; late care entry
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12762

Introduction Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. Methods Cross‐sectional data were collected for 3972 HIV‐infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000–2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/μL or history of AIDS‐defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/μL or history of AIDS) were identified. Results The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46–4.47] for late presentation and 3.13 (95% CI 1.49–6.58) for advanced disease for the 21–30‐year‐old category to 5.2 (95% CI 1.94–14.04) and 8.15 (95% CI 2.88–23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16–2.60) and 1.55 (95% CI 1.05–2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31–0.59) and 0.39 (95% CI 0.29–0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. Conclusions Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.