AEGiS-14IAC: Delayed access to care for HIV-infected patients in France and consequences.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Delayed access to care for HIV-infected patients in France and consequences.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10688)

Mary-Krause M, Barberousse C, Perbost I, Tattevin P, Poizot-Martin I, Dupont C, Costagliola D
Inserm SC4, Paris, France

BACKGROUND: After the large impact of HAART on AIDS and death incidences, they remain stable. Many factors can contribute to this phenomenon including late HIV testing, late access to care and treatment failure. The objective of this study was to describe HIV-infected subjects with delayed access to care and the consequences on their survival.

METHODS: The French Hospital Database on HIV includes data relative to HIV-seropositive subjects followed in 68 hospitals. A standardised follow-up form is used at each visit or hospital admission when a change in clinical manifestation, treatment or biological markers appears, or at least every 6 months. Subjects with delayed access to care were defined as those with CD4 cell count<200/mm³ at their first contact with the hospital either as out-or in-patient (G1) and compared with subjects presenting with CD4>200/mm³ when first attending the hospital (G2).

RESULTS: Among 12 943 subjects with a first contact with hospital between 1997 and 1999 (periods where HAART treatments were available), 4138 (32%) had CD4<200/mm³. The median CD4 at entry was 84 for G1 and 423 for G2. Men had more often delayed access to care (77.5% in G1 vs 70.9 in G2, p=0.001). Homosexual men and heterosexual subjects were 28% and 42% in G1 and 34% and 39% in G2 respectively (p<10-4). 57% of G1 known their serology within 3 months before vs 43% for G2 (p<0.001). Patients in G1 accounted for nearly 60% of the newly diagnosed AIDS cases between 1997 and 1999. Moreover, the survival rate at one year was estimated as 88 % in G1 as compared to 99% in G2 (P<0.001) while the delay between first contact and prescription of triple therapy was similar in both groups.

CONCLUSIONS: Subjects with delayed access to care tend to learn their serology very late, and be more often male. Moreover, most of death and AIDS concerned subjects who accessed HIV care late in the course of infection. Our results pointed out the need to improve HIV testing and access to care.

Keywords: AEGIS, HIV Infections, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome, Antiretroviral Therapy, Highly Active, HIV Seropositivity, Incidence, France, Heterosexuality, Human, Male

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C10688