Multicenter epidemiological study to describe prevalence of advanced stage disease among newly diagnosed HIV‐infected patients in the Russian Federation
Authors: Pronin A , Orlova‐Morozova E , Kaminskiy G , Sizova N , Ryamova E , Plotnikova J , Sibill K , Kozyrev O , Ibragimova L , Nagimova F , Fedotov D , Trinh R , Van de Steen O , Zachry W , Kruglova A 
Published: November 2012

Purpose of the study

The proportion of HIV‐infected persons diagnosed in an advanced stage of HIV disease (ASH) varies by country from 15 to 30%. Data are lacking on the proportion of new cases diagnosed in this late stage in Russia. The aim of this study was to estimate the proportion of and further characterize patients with ASH among newly diagnosed HIV‐1 infected persons in the Russian Federation.

Methods

This was a cross‐sectional, multicenter, epidemiologic study. Adult HIV‐1 patients that were newly diagnosed within 90 days and naïve to highly active antiretroviral therapy were included at twelve centers/regions (Moscow Region, St Petersburg, Leningrad Region, Ufa, Kazan, Ulyanovsk, Volgograd, Yekaterinburg, Kemerovo, Krasnoyarsk, Irkutsk and Vladivostok) of the Russian Federation. ASH was defined as a CD4+ cell count ≤200 cells/mm3. Pairwise, two‐tailed comparisons were conducted with an unadjusted 5% significance level. For comparison variables between patients with ASH and all other patients, Pearson's chi‐square test was used.

Summary of results

4540 patients were included. The overall proportion of ASH was 16.3% (95% CI; 15.3%, 17.4%). The median plasma HIV‐1 RNA was 4.48 (Q1, Q3; 3.81, 5.07) log10 copies/mL. The proportion of patients with CD4+ cell count by categories is presented in Figure 1.

ASH was associated with male sex (62.3%), 26‐40 and >40 years age groups, rural place of residence (18.9%), only primary and/or basic school education (complete or not complete) (39.4%), unemployment (40.5%), intravenous drug user as mode of HIV‐1 transmission (39.5%), patient with clinical signs of immunodeficiency or condition related to HIV/AIDS as reason for primary HIV‐1 testing (35.2%), HBV (5.4%), HCV (44.0%) as partly shown in Table 1.

Conclusions

The overall prevalence of ASH was 16.3%. At least 9 factors associated with ASH were revealed. Knowledge of these factors is valuable for planning, prevention and post‐diagnosis services for HIV‐infected patients presenting with advance stage disease.

Proportion of newly HIV infected patients by CD4+ count categories, % (n=4540).

image

Descriptive statistics of newly HIV‐infected patients

Total
CD4+ cell count ≤ 200 cells/mm3
CD4+ cell count ≥ 200 cells/mm3
p‐value*

4540
741
3799

Age

Mean (SD)
32.6 (8.7)
35.5 (8.9)
32.1 (8.6)
<0.0001

Median
31.0
33.0
30.0

Age group

18‐25 yr
901 (19.8%)
52 (7.0%)
849 (22.3%)
<0.0001

26‐40 yr
2921 (64.3%)
512 (69.1%)
2409 (63.4%)

>40 yr
718 (15.8%)
177 (23.9%)
541 (14.2%)

Gender

Male
2289 (50.4%)
462 (62.3%)
1827 (48.1%)
<0.0001

Female
2251 (49.6%)
279 (37.7%)
1972 (51.9%)

HIV mode of transmission

Heterosexual contact
2801 (61.7%)
390 (52.6%)
2411 (63.5%)
<0.0001

Homosexual contact
99 (2.2%)
21 (2.8%)
78 (2.1%)

Intravenous drug user (IVDU)
1388 (30.6%)
293 (39.5%)
1095 (28.8%)

Blood transfusion, organ transplant or healthcare contact
3 (0.1%)
1 (0.1%)
2 (0.1%)

Unknown
249 (5.5%)
36 (4.9%)
213 (5.6%)

Chronic hepatitis B

No
4362 (96.1%)
701 (94.6%)
3661 (96.4%)
0.0235

Yes
178 (3.9%)
40 (5.4%)
138 (3.6%)

Chronic hepatitis C

No
3001 (66.1%)
415 (56.0%)
2586 (68.1%)
<0.0001

Yes
1539 (33.9%)
326 (44.0%)
1213 (31.9%)

Analysis result of comparison of HIV‐1‐infected patients with advanced stage disease vs. all other patients. Tests resulting in p‐values less than or equal to 0.05 are reported as ‘statistically significant’.