Late-stage disease at presentation to an HIV clinic in eastern Tanzania: A retrospective cross-sectional study.

BACKGROUND Late presentation and delayed treatment initiation is associated with poor outcomes in patients with HIV. Little is known about the stage at which HIV patients present at HIV clinics in Tanzania. AIM This study aimed at determining the proportion of HIV patients presenting with WHO clinical stages 3 and 4 disease, and the level of immunity at the time of enrollment at the care and treatment center. METHODS A retrospective cross-sectional study was conducted among 366 HIV-infected adults attending HIV clinic at Mwananyamala Hospital in Dar es Salaam, Tanzania. Data were obtained from the care and treatment clinic database. RESULTS Late stage disease at the time of presentation was found in 276 (75.4%) of the patients; out of whom 153 (41.8%) presented with CD4 count <200 cells/ul and 229 (62.6%) presented with WHO clinical stage 3 or 4 at the time of clinic enrollment. Strategies to improve early diagnosis and treatment initiation should be improved.

[1]  K. Mate,et al.  Inpatient mortality of HIV-infected adults in sub-Saharan Africa and possible interventions: a mixed methods review , 2014, BMC Health Services Research.

[2]  R. Remien,et al.  Advanced disease at enrollment in HIV care in four sub-Saharan African countries: change from 2006 to 2011 and multilevel predictors in 2011 , 2014, AIDS.

[3]  T. Tylleskär,et al.  Dramatic and sustained increase in HIV-testing rates among antenatal attendees in Eastern Uganda after a policy change from voluntary counselling and testing to routine counselling and testing for HIV: a retrospective analysis of hospital records, 2002-2009 , 2010, BMC health services research.

[4]  Jeffrey N. Martin,et al.  Late-Disease Stage at Presentation to an HIV Clinic in the Era of Free Antiretroviral Therapy in Sub-Saharan Africa , 2009, Journal of acquired immune deficiency syndromes.

[5]  Jeffrey N. Martin,et al.  Incomplete peripheral CD4+ cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  A. Levy,et al.  Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. , 2008, The Journal of infectious diseases.

[7]  G. Mengistu,et al.  Immune reconstitution inflammatory syndrome among HIV/AIDS patients during highly active antiretroviral therapy in Addis Ababa, Ethiopia. , 2008, Japanese journal of infectious diseases.

[8]  C. Sabin,et al.  Late Diagnosis of HIV Infection: Epidemiological Features, Consequences and Strategies to Encourage Earlier Testing , 2007, Journal of acquired immune deficiency syndromes.

[9]  J. Sterne,et al.  Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries , 2006, The Lancet.

[10]  M. Gill,et al.  The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection , 2004, HIV medicine.