Frequency, determinants and consequences of delayed access to care for HIV infection in France

Antivir Ther. 2007;12(1):89-96.

Abstract

Background and objectives: We analysed the frequency and predictors of delayed access to care (DAC) for HIV infection, and its influence on survival.

Methods: We studied predictors of DAC among 18,721 patients enrolled between 1997 and 2002 in the French Hospital Database on HIV (FHDH), DAC being defined by a CD4* T-cell count below 200 copies/mm3 and/or AIDS at FHDH enrollment. The association of DAC with the initiation of combined antiretroviral therapy (cART) and of DAC with survival were analysed with Cox multivariable models.

Results: The overall prevalence of DAC was 35.7%. Compared with patients under 30 years of age, patients over 60 were 3.5 times more likely to have DAC (P < 10(-4)). Compared with non-migrant women, odds ratios (OR) of DAC were higher among migrant women (1.5), non-migrant men (1.6) and migrant men (1.9; all P < 10(-4)). Compared with men who have sex with men, other transmission groups had an estimated OR for DAC of 1.6 (P < 10(-4)). DAC was more frequent among patients with a recent diagnosis of HIV infection [OR = 1.3, 95% confidence intervals (CI) = (1.2;1.4)]. Patients with DAC received cART earlier than other patients [hazard ratio (HR) = 2.2, 95% CI = (2.1;2.3)]. The DAC/mortality HR was 13.9 in the first 6 months after enrollment in the FHDH, and remained significantly higher than 1 during the subsequent 4 years.

Conclusion: DAC is common in France and was associated with a higher mortality, despite early initiation of cART. Earlier access to care and specific clinical management of patients with DAC should be considered.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / immunology
  • Acquired Immunodeficiency Syndrome / mortality
  • Adult
  • Age Factors
  • Anti-Retroviral Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Databases as Topic
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • HIV Infections / mortality
  • Health Services Accessibility* / statistics & numerical data
  • Homosexuality, Male
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Acceptance of Health Care
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Transients and Migrants
  • Treatment Outcome

Substances

  • Anti-Retroviral Agents