May 17, 2007

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

Antiviral Therapy
Emilie LanoyANRS C004 French Hospital Database on HIV Clinical Epidemiological Group


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

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Mentioned in this Paper

Anti-Retroviral Agents
Transcription Initiation
Incidence Studies
HIV Infections
Odds Ratio
Health Care Seeking Behavior
CD4 Count Determination Procedure
Cox Proportional Hazards Models

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