Late diagnosis in the HAART era: proposed common definitions and associations with mortality
To identify a definition of presentation after clinical or immunological disease progression that will reliably identify an individual at high risk of mortality over the first 3 months after HIV diagnosis and that can be adopted as a basis for comparing over time and regions. An observational cohort...
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| Veröffentlicht in: | AIDS (London) 2010-03, Vol.24 (5), p.723-727 |
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| creator | Sabin, Caroline A Schwenk, Achim Johnson, Margaret A Gazzard, Brian Fisher, Martin Walsh, John Orkin, Chloe Hill, Teresa Gilson, Richard Porter, Kholoud Easterbrook, Philippa Delpech, Valerie Bansi, Loveleen Leen, Clifford Gompels, Mark Anderson, Jane Phillips, Andrew N |
| description | To identify a definition of presentation after clinical or immunological disease progression that will reliably identify an individual at high risk of mortality over the first 3 months after HIV diagnosis and that can be adopted as a basis for comparing over time and regions.
An observational cohort study.
Individuals seen for the first time at a UK Collaborative HIV Cohort study clinic from 1996 to 2006 were identified. Two immunological (CD4 cell count < 200 cells/microl and CD4 cell count |
| doi_str_mv | 10.1097/QAD.0b013e328333fa0f |
| format | Article |
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An observational cohort study.
Individuals seen for the first time at a UK Collaborative HIV Cohort study clinic from 1996 to 2006 were identified. Two immunological (CD4 cell count < 200 cells/microl and CD4 cell count <50 cells/microl) and two clinical (AIDS and severe/moderate AIDS) criteria for presentation with advanced HIV disease were compared, as well as combinations of them. The predictive ability of each diagnosis for identifying individuals who died in the first 3 months after HIV diagnosis was assessed.
Fifteen thousand seven hundred and seventy-four patients were included, of whom 1495 (9.5%), 4231 (26.8%), 1523 (9.7%) and 379 (2.4%) had a CD4 cell count below 50 cells/microl, CD4 cell count below 200 cells/microl, AIDS or severe/moderate AIDS at diagnosis; CD4 cell counts were unavailable for 2264 (14.4%) patients. Two hundred and six (1.3%) patients died within the first 3 months. Sensitivities of the individual criteria ranged from 18.0% (severe/moderate AIDS) to 50.5% (CD4 cell count < 200 cells/microl) with specificities ranging from 73.5% (CD4 < 200 cells/microl) to 97.8% (severe/moderate AIDS). Combinations of clinical and immunological criteria increased the sensitivity but decreased the specificity.
We propose that presentation with 'advanced HIV disease' is presentation with a CD4 cell count below 200 cells/microl or AIDS, whereas 'late' presentation is defined as presentation when the CD4 cell count is below that when treatment should be initiated (currently CD4 cell count < 350 cells/microl or AIDS).</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0b013e328333fa0f</identifier><identifier>PMID: 20057312</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acquired immune deficiency syndrome ; Adult ; AIDS/HIV ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral Therapy, Highly Active - mortality ; Antiviral agents ; Biological and medical sciences ; CD4 antigen ; CD4 Lymphocyte Count ; Cohort Studies ; Delayed Diagnosis - mortality ; Disease Progression ; Female ; highly active antiretroviral therapy ; HIV Infections - diagnosis ; HIV Infections - immunology ; HIV Infections - mortality ; HIV-1 ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunological diseases ; Infectious diseases ; Male ; Medical sciences ; Mortality ; Pharmacology. Drug treatments ; Prognosis ; Risk factors ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>AIDS (London), 2010-03, Vol.24 (5), p.723-727</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-3911cd59007d46f4a2fd264514903bfa0ab778b9b349e06e9155615b0ea058553</citedby><cites>FETCH-LOGICAL-c368t-3911cd59007d46f4a2fd264514903bfa0ab778b9b349e06e9155615b0ea058553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22592280$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20057312$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sabin, Caroline A</creatorcontrib><creatorcontrib>Schwenk, Achim</creatorcontrib><creatorcontrib>Johnson, Margaret A</creatorcontrib><creatorcontrib>Gazzard, Brian</creatorcontrib><creatorcontrib>Fisher, Martin</creatorcontrib><creatorcontrib>Walsh, John</creatorcontrib><creatorcontrib>Orkin, Chloe</creatorcontrib><creatorcontrib>Hill, Teresa</creatorcontrib><creatorcontrib>Gilson, Richard</creatorcontrib><creatorcontrib>Porter, Kholoud</creatorcontrib><creatorcontrib>Easterbrook, Philippa</creatorcontrib><creatorcontrib>Delpech, Valerie</creatorcontrib><creatorcontrib>Bansi, Loveleen</creatorcontrib><creatorcontrib>Leen, Clifford</creatorcontrib><creatorcontrib>Gompels, Mark</creatorcontrib><creatorcontrib>Anderson, Jane</creatorcontrib><creatorcontrib>Phillips, Andrew N</creatorcontrib><creatorcontrib>UK Collaborative HIV Cohort (UK CHIC) Steering Committee</creatorcontrib><title>Late diagnosis in the HAART era: proposed common definitions and associations with mortality</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>To identify a definition of presentation after clinical or immunological disease progression that will reliably identify an individual at high risk of mortality over the first 3 months after HIV diagnosis and that can be adopted as a basis for comparing over time and regions.
An observational cohort study.
Individuals seen for the first time at a UK Collaborative HIV Cohort study clinic from 1996 to 2006 were identified. Two immunological (CD4 cell count < 200 cells/microl and CD4 cell count <50 cells/microl) and two clinical (AIDS and severe/moderate AIDS) criteria for presentation with advanced HIV disease were compared, as well as combinations of them. The predictive ability of each diagnosis for identifying individuals who died in the first 3 months after HIV diagnosis was assessed.
Fifteen thousand seven hundred and seventy-four patients were included, of whom 1495 (9.5%), 4231 (26.8%), 1523 (9.7%) and 379 (2.4%) had a CD4 cell count below 50 cells/microl, CD4 cell count below 200 cells/microl, AIDS or severe/moderate AIDS at diagnosis; CD4 cell counts were unavailable for 2264 (14.4%) patients. Two hundred and six (1.3%) patients died within the first 3 months. Sensitivities of the individual criteria ranged from 18.0% (severe/moderate AIDS) to 50.5% (CD4 cell count < 200 cells/microl) with specificities ranging from 73.5% (CD4 < 200 cells/microl) to 97.8% (severe/moderate AIDS). Combinations of clinical and immunological criteria increased the sensitivity but decreased the specificity.
We propose that presentation with 'advanced HIV disease' is presentation with a CD4 cell count below 200 cells/microl or AIDS, whereas 'late' presentation is defined as presentation when the CD4 cell count is below that when treatment should be initiated (currently CD4 cell count < 350 cells/microl or AIDS).</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS/HIV</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral Therapy, Highly Active - mortality</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Cohort Studies</subject><subject>Delayed Diagnosis - mortality</subject><subject>Disease Progression</subject><subject>Female</subject><subject>highly active antiretroviral therapy</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - immunology</subject><subject>HIV Infections - mortality</subject><subject>HIV-1</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunological diseases</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Pharmacology. Drug treatments</subject><subject>Prognosis</subject><subject>Risk factors</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtL5EAQx5tFWcfHN5ClL-IpWt3Vj7S3wce6MCCK3oRQSTraS5Ie0xnEb29kZlfw4qmK4vev15-xQwEnApw9vZ1fnEAJAj3KHBEbguYHmwllMdPaii02A2lc5tDCDttN6S8AaMjzn2xHTplFIWfscUGj53Wgpz6mkHjo-fjs-fV8fnfP_UBnfDnEZUy-5lXsutjz2jehD2OIfeLU15xSilWgdeE1jM-8i8NIbRjf9tl2Q23yB5u4xx6uLu_Pr7PFze8_5_NFVqHJxwydEFWtHYCtlWkUyaaWRmmhHGA53UWltXnpSlTOg_FOaG2ELsET6Fxr3GPH677Tri8rn8aiC6nybUu9j6tUWKVz5wyq70lEI5U1ZiLVmqyGmNLgm2I5hI6Gt0JA8WFAMRlQfDVgkv3aDFiVna__i_59fAKONgClitpmoL4K6ZOT2kmZA74DrJyOXQ</recordid><startdate>20100313</startdate><enddate>20100313</enddate><creator>Sabin, Caroline A</creator><creator>Schwenk, Achim</creator><creator>Johnson, Margaret A</creator><creator>Gazzard, Brian</creator><creator>Fisher, Martin</creator><creator>Walsh, John</creator><creator>Orkin, Chloe</creator><creator>Hill, Teresa</creator><creator>Gilson, Richard</creator><creator>Porter, Kholoud</creator><creator>Easterbrook, Philippa</creator><creator>Delpech, Valerie</creator><creator>Bansi, Loveleen</creator><creator>Leen, Clifford</creator><creator>Gompels, Mark</creator><creator>Anderson, Jane</creator><creator>Phillips, Andrew N</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope></search><sort><creationdate>20100313</creationdate><title>Late diagnosis in the HAART era: proposed common definitions and associations with mortality</title><author>Sabin, Caroline A ; Schwenk, Achim ; Johnson, Margaret A ; Gazzard, Brian ; Fisher, Martin ; Walsh, John ; Orkin, Chloe ; Hill, Teresa ; Gilson, Richard ; Porter, Kholoud ; Easterbrook, Philippa ; Delpech, Valerie ; Bansi, Loveleen ; Leen, Clifford ; Gompels, Mark ; Anderson, Jane ; Phillips, Andrew N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-3911cd59007d46f4a2fd264514903bfa0ab778b9b349e06e9155615b0ea058553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adult</topic><topic>AIDS/HIV</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiretroviral Therapy, Highly Active - mortality</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Cohort Studies</topic><topic>Delayed Diagnosis - mortality</topic><topic>Disease Progression</topic><topic>Female</topic><topic>highly active antiretroviral therapy</topic><topic>HIV Infections - diagnosis</topic><topic>HIV Infections - immunology</topic><topic>HIV Infections - mortality</topic><topic>HIV-1</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunological diseases</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Pharmacology. Drug treatments</topic><topic>Prognosis</topic><topic>Risk factors</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sabin, Caroline A</creatorcontrib><creatorcontrib>Schwenk, Achim</creatorcontrib><creatorcontrib>Johnson, Margaret A</creatorcontrib><creatorcontrib>Gazzard, Brian</creatorcontrib><creatorcontrib>Fisher, Martin</creatorcontrib><creatorcontrib>Walsh, John</creatorcontrib><creatorcontrib>Orkin, Chloe</creatorcontrib><creatorcontrib>Hill, Teresa</creatorcontrib><creatorcontrib>Gilson, Richard</creatorcontrib><creatorcontrib>Porter, Kholoud</creatorcontrib><creatorcontrib>Easterbrook, Philippa</creatorcontrib><creatorcontrib>Delpech, Valerie</creatorcontrib><creatorcontrib>Bansi, Loveleen</creatorcontrib><creatorcontrib>Leen, Clifford</creatorcontrib><creatorcontrib>Gompels, Mark</creatorcontrib><creatorcontrib>Anderson, Jane</creatorcontrib><creatorcontrib>Phillips, Andrew N</creatorcontrib><creatorcontrib>UK Collaborative HIV Cohort (UK CHIC) Steering Committee</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sabin, Caroline A</au><au>Schwenk, Achim</au><au>Johnson, Margaret A</au><au>Gazzard, Brian</au><au>Fisher, Martin</au><au>Walsh, John</au><au>Orkin, Chloe</au><au>Hill, Teresa</au><au>Gilson, Richard</au><au>Porter, Kholoud</au><au>Easterbrook, Philippa</au><au>Delpech, Valerie</au><au>Bansi, Loveleen</au><au>Leen, Clifford</au><au>Gompels, Mark</au><au>Anderson, Jane</au><au>Phillips, Andrew N</au><aucorp>UK Collaborative HIV Cohort (UK CHIC) Steering Committee</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late diagnosis in the HAART era: proposed common definitions and associations with mortality</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2010-03-13</date><risdate>2010</risdate><volume>24</volume><issue>5</issue><spage>723</spage><epage>727</epage><pages>723-727</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract>To identify a definition of presentation after clinical or immunological disease progression that will reliably identify an individual at high risk of mortality over the first 3 months after HIV diagnosis and that can be adopted as a basis for comparing over time and regions.
An observational cohort study.
Individuals seen for the first time at a UK Collaborative HIV Cohort study clinic from 1996 to 2006 were identified. Two immunological (CD4 cell count < 200 cells/microl and CD4 cell count <50 cells/microl) and two clinical (AIDS and severe/moderate AIDS) criteria for presentation with advanced HIV disease were compared, as well as combinations of them. The predictive ability of each diagnosis for identifying individuals who died in the first 3 months after HIV diagnosis was assessed.
Fifteen thousand seven hundred and seventy-four patients were included, of whom 1495 (9.5%), 4231 (26.8%), 1523 (9.7%) and 379 (2.4%) had a CD4 cell count below 50 cells/microl, CD4 cell count below 200 cells/microl, AIDS or severe/moderate AIDS at diagnosis; CD4 cell counts were unavailable for 2264 (14.4%) patients. Two hundred and six (1.3%) patients died within the first 3 months. Sensitivities of the individual criteria ranged from 18.0% (severe/moderate AIDS) to 50.5% (CD4 cell count < 200 cells/microl) with specificities ranging from 73.5% (CD4 < 200 cells/microl) to 97.8% (severe/moderate AIDS). Combinations of clinical and immunological criteria increased the sensitivity but decreased the specificity.
We propose that presentation with 'advanced HIV disease' is presentation with a CD4 cell count below 200 cells/microl or AIDS, whereas 'late' presentation is defined as presentation when the CD4 cell count is below that when treatment should be initiated (currently CD4 cell count < 350 cells/microl or AIDS).</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20057312</pmid><doi>10.1097/QAD.0b013e328333fa0f</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-9370 |
| ispartof | AIDS (London), 2010-03, Vol.24 (5), p.723-727 |
| issn | 0269-9370 1473-5571 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_745899634 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Acquired immune deficiency syndrome Adult AIDS/HIV Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral Therapy, Highly Active - mortality Antiviral agents Biological and medical sciences CD4 antigen CD4 Lymphocyte Count Cohort Studies Delayed Diagnosis - mortality Disease Progression Female highly active antiretroviral therapy HIV Infections - diagnosis HIV Infections - immunology HIV Infections - mortality HIV-1 Human immunodeficiency virus Human viral diseases Humans Immunological diseases Infectious diseases Male Medical sciences Mortality Pharmacology. Drug treatments Prognosis Risk factors Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Late diagnosis in the HAART era: proposed common definitions and associations with mortality |
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