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Late presentation of HIV-infected individuals

Battegay, Manuel
Fluckiger, Ursula
Furrer, Hansjakob
Published in Antiviral Therapy. 2007, vol. 12, no. 6, p. 841-851
Abstract Late presentation remains a major concern despite the dramatically improved prognosis realized by ART. We define a first presentation for HIV care during the course of HIV infection as 'late' if an AIDS-defining opportunistic disease is apparent, or if CD4+ T-cells are <200/microl. In the Western world, approximately 10 and 30% of HIV-infected individuals still present with CD4+ T-cells <50 and <200/microl, respectively; estimates are substantially higher for developing countries. Diagnosis and treatment of opportunistic diseases and intense supportive in-hospital care take precedence over ART. Benefits of starting ART without delay, that is, when opportunistic diseases are still active, include faster resolution of opportunistic diseases and a decreased risk of recurrence. The downside of starting ART without delay could include toxicity, drug interactions and immune reconstitution inflammatory syndrome (IRIS). Among asymptomatic or oligosymptomatic individuals presenting late, where ART and primary prophylaxis are initiated, approximately 10-20% will become symptomatic from drug toxicity or undiagnosed opportunistic complications, including IRIS, which require appropriate therapies. In this review we describe late presentation to HIV care, the scale of the problem, the evaluation of a late-presenting patient and challenges associated with initiation of potent antiretroviral therapy (ART) in the setting of acute opportunistic infections and other comorbidities.
Keywords AIDS-Related Opportunistic Infections/complications/ prevention & controlAnti-HIV Agents/ therapeutic useAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountDiagnosis, DifferentialHIV Infections/diagnosis/ drug therapy/immunology/virologyHumans
PMID: 17926639
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BATTEGAY, Manuel et al. Late presentation of HIV-infected individuals. In: Antiviral Therapy, 2007, vol. 12, n° 6, p. 841-851. https://archive-ouverte.unige.ch/unige:7094

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Deposited on : 2010-06-21

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