HIV patients sicker when seeking care than in the past
25-Oct-2007 - It was hoped that as HIV treatment improved and as HIV-related public health initiatives encouraged
people to be tested for the disease and seek care, that HIV-infected patients would seek care quickly. Unfortunately,
a new study indicates that patients are actually sicker when they begin therapy. The study is published in the November
15 issue of Clinical Infectious Diseases, currently available online.
The study, carried out in Baltimore, MD, from 1990 through 2006, shows that HIV patients beginning HIV
therapy have trended toward increasing levels of immunocompromise. This is probably an indicator that people are getting
tested for HIV later after they've contracted the disease than in the past. Also, people in several key demographic groups
are not any quicker now to seek care than they were in the past and some are even taking longer.
HIV is a disease that is most effectively treated if caught early in the course of the illness. Early
treatment also helps to limit the spread of the virus from one person to another. For these reasons, HIV services in the
United States have evolved over time to encourage people to be tested for HIV and seek treatment if infected.
The researchers, Jeanne Keruly, MS and Richard Moore, MD, of Johns Hopkins University School of Medicine
in Baltimore, analyzed data from over 3,300 patients seeking HIV care from the Johns Hopkins HIV service. The data were
examined both as a whole and as demographic subsets including gender, race, injecting drug use, men who have sex with
men, and heterosexuals. They looked at the amount of time between a patient's diagnosis of HIV and the time when that
person first sought care; and they looked at the patient's immune status at the time of first care. Ideally, they
would have found trends that showed a decrease in the time between diagnosis and treatment and an increase in the
immune status.
During the years analyzed, men-and in particular white men and men who have sex with men-did have a trend
towards seeking care more quickly after receiving an initial diagnosis of HIV. For all men, the average length between
diagnosis and presentation for care was 270 days at the beginning of the study, falling to 183 days by the end.
Women's times to seek treatment, on the other hand, stayed fairly constant. And, unfortunately, injection
drug users had a dramatic increase in the time until treatment, from an average of 378 days at the beginning of the study to 630 days at the conclusion.
People in all but one of the demographic categories had a trend of increasing immunocompromise, an
indicator of disease development. The level of immunocompromise was such that the person was at increased risk for
a poorer clinical outcome from antiretroviral therapy than if they had presented earlier for care. Over time, patients
were increasingly likely to present with AIDS or HIV symptoms. The exception was in the men who have sex with men
category.
In light of what appears to have been a poor response to efforts to more rapidly diagnose and treat
HIV patients in Maryland, the authors call for new strategies to provide earlier HIV testing and referral into care.
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Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety
of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published
under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Virginia, IDSA is a
professional society representing more than 8,300 physicians and scientists who specialize in infectious diseases.
Nested within the IDSA, the HIV Medicine Association (HIVMA) is the professional home for more than 3,500 physicians,
scientists and other health care professionals dedicated to the field of HIV/AIDS. HIVMA promotes quality in HIV care
and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and
social justice. For more information, visit
and .
Contact:
Steve Baragona
sbaragona@idsociety.org
703-299-0412
Infectious Diseases Society of America
"Reproduced with permission - Infectious Diseases Society of America"
Infectious Diseases Society of America
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