Late presentation of HIV-infected individuals

Battegay, Manuel; Fluckiger, Ursula; Hirschel, Bernard; Furrer, Hansjakob (2007). Late presentation of HIV-infected individuals. Antiviral therapy, 12(6), pp. 841-51. London: International Medical Press

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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.

Item Type:	Journal Article (Further Contribution)
Division/Institute:	04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
UniBE Contributor:	Furrer, Hansjakob
ISSN:	1359-6535
ISBN:	17926639
Publisher:	International Medical Press
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:59
Last Modified:	05 Dec 2022 14:18
PubMed ID:	17926639
Web of Science ID:	000249773400001
URI:	https://boris.unibe.ch/id/eprint/25676 (FactScience: 60450)