The introduction of highly active antiretroviral therapy paradoxically increased a late diagnosis of HIV infection, often coinciding with full-blown AIDS
Abstract number: 1134_01_284
Manfredi R., Calza L., Chiodo F.
Notwithstanding the availability of HAART since 1996,AIDS notifications continue to occur, with increasing frequency among patients (p) who were not aware of their condition, or neglected specific monitoring and treatment.
Patients and Methods:
All cases of AIDS newly diagnosed since 2001 at our centre were compared with all AIDS episodes observed in the decade preceding HAART introduction (19861995),on the ground of a broad spectrum of epidemiological and clinical variables.
Compared with the pre-HAART era, the expected drop of frequency of overall AIDS cases were seen: from a mean of ~58 p from 1986 to 1995, to ~17 p per year since 2001 (p < 0.001). An increased mean age at diagnosis (p < 0.003), a more frequent involvement of women (p < 0.02), an increased sexual exposure vs i.v. drug abuse (p < 0.001), and a higher proportion of foreign p (p < 0.04),were found. After HAART introduction, the most evident drop of incidence of AIDS-associated opportunism involved all diseases linked to a very deep immunodeficiency (as expressed by a CD4 count (50100 cells/mL), while a proportional increase of lymphomas, tuberculosis, and bacterial pneumonia occurred. Both examined periods were characterised by the persistence of Candida esophagitis and pneumocystosis as the most frequent AIDS-defining diseases, followed by neurotoxoplamosis, wasting syndrome, and AIDS dementia. Both absolute number and proportion of p with multiple concurrent AIDS-related disorders had a paradoxical increase just during the HAART era, as well as AIDS diagnoses notified at death (p < 0.001), while AIDS-associated immunodeficiency did not change significantly. Surprisingly, a prior use of antiretrovirals was more common among AIDS p until 1995, vs p diagnosed since 2001 (p < 0.001), since during recent years an AIDS diagnosis tends to be made concurrently with the first positivity of HIV serology.
When facing p with suspected opportunistic illnessess, the Clinician should maintain an elevated clinical suspicion for an advanced, but occult and untreated HIV disease. An increased attention to this emerging problem may allow a more rapid recognition of suspected p, and an appropriate therapy of p who could not benefit from HAART, since they were unaware of their disease, or removed their problem (when p lost to follow-up or p who previously refused follow-up and cure, are of concern).
|Session name:||XXIst ISTH Congress|
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