Clinicoepidemiological Characteristics of HIV-Infected Immigrants Attended at a Tropical Medicine Referral Unit

被引:19
作者
Perez-Molina, Jose A. [1 ]
Lopez-Velez, Rogelio [1 ]
Navarro, Miriam [1 ]
Perez-Elias, Maria J.
Moreno, Santiago
机构
[1] Hosp Ramon & Cajal, Dept Infect Dis, Trop Med & Clin Parasitol Unit, E-28034 Madrid, Spain
关键词
VIRUS-INFECTION; EPIDEMIOLOGY; COHORT; HEALTH;
D O I
10.1111/j.1708-8305.2009.00308.x
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background Migration is a growing phenomenon with a well-known impact in infectious diseases epidemiology. Currently, immigrants represent almost 10% of the Spanish population. The majority come from countries where the prevalence of chronic viral illnesses is higher than in Spain. Methods To describe clinicoepidemiological features of human immunodeficiency virus (HIV)-infected immigrants attending our Unit and to compare differential characteristics depending on geographical origin, information from all new immigrants from January 1997 to December 2006 was collected. Study design: noninterventional retrospective chart review. Results We screened 1,609 patients of whom 77 (4.8%) were HIV antibody (Ab) positive. Of these, 80% were sub-Saharan Africans (SSAFR) and 20% were South-Central Americans (SCA). HIV prevalence was higher in SSAFR (5.6% vs 3.2%; p = 0.04). Overall, of those who were HIV Ab positive, 70% were male (median age 30 years), 59% heterosexuals, 9% hepatitis C virus coinfected, 8.6% hepatitis B virus coinfected, and 34% showed a positive tuberculin skin test. Median CD4 cell count was 263 cells/mu L, median HIV-ribonucleic acid viral load 4.6 Log/mL, and 48% had a late diagnosis [acquired immunodeficiency syndrome (AIDS)-defining illness or < 200 CD4 mu L at the time of diagnosis]. Only 68% of patients for whom antiretroviral therapy was indicated actually started therapy and 22% were lost to follow-up just after diagnosis. SCA had lower CD4 cell counts (26 vs 168 cells/mu L; p = 0.016), higher viral loads (5.3 vs 4.8 Log; p = 0.001), and were more likely to have an AIDS-defining illness (53% vs 21%; p = 0.04) compared to SSAFR. Tuberculin skin test reactivity was more common among SSAFR versus SCA [adjusted by CD4 count, odds ratio (OR) 6.3 and 95% confidence interval (CI): 0.65-60.5]. The main risk factor for late diagnosis was geographical origin: OR 4.6 (95% CI: 1.11-19.3) (SCA vs SSAFR; adjusted by the interval between the date of arrival in Spain and the date of HIV diagnosis). Conclusions Almost half the HIV-infected immigrants were diagnosed in late stages. Patients were frequently lost to follow-up, and a significant minority did not start highly active antiretroviral therapy when indicated. SCA seem to have more severe immunosuppression at the time of diagnosis than SSAFR. Early voluntary routine HIV screening should be promoted.
引用
收藏
页码:248 / 252
页数:5
相关论文
共 22 条
[1]  
Aldeguer L, 2007, ENFERM INFEC MICR CL, V25, P32, DOI 10.1157/13096750
[2]  
[Anonymous], WORLD MIGR 2003 MAN
[3]   The relationship of patient reading ability to self-reported health and use of health services [J].
Baker, DW ;
Parker, RM ;
Williams, MV ;
Clark, WS ;
Nurss, J .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1997, 87 (06) :1027-1030
[4]   Health and literacy in first- and second-generation Moroccan Berber women in the Netherlands: III literacy? [J].
Bekker M.H.J. ;
Lhajoui M. .
International Journal for Equity in Health, 3 (1)
[5]   Spanish cohort of naive HIV-infected patients (CoRIS):: Rationale, organization and initial results [J].
Caro-Murillo, Ana Maria ;
Castilla, Jesus ;
Perez-Hoyos, Santiago ;
Miro, Jose M. ;
Podzamczer, Daniel ;
Rubio, Rafael ;
Riera, Melchor ;
Viciana, Pompeyo ;
Lopez Aldeguer, Jose ;
Iribarren, Jose Antonio ;
de los Santos-Gil, Ignacio ;
Gomez-Sirvent, Juan Luis ;
Berenguer, Juan ;
Gutierrez, Felix ;
Saumoy, Maria ;
Segura, Ferran ;
Soriano, Vicente ;
Pena, Alejandro ;
Pulido, Federico ;
Oteo, Jose Antonio ;
Leal, Manuel ;
Casabona, Jordi ;
del Amo, Julia ;
Moreno, Santiago .
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA, 2007, 25 (01) :23-31
[6]  
*DHHS PAN ANT GUID, 2007, GUID US ANT AG HIV 1
[7]   Globalization of infectious diseases: The impact of migration [J].
Gushulak, BD ;
MacPherson, DW .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (12) :1742-1748
[8]   HIV infection in immigrants:: clinical and epidemiological differences as compared to the native population in a Health Area in Madrid (2002-2004) [J].
Hernando Jerez, Asuncion ;
Garcia-Cerrada, Carlos ;
Pulido Ortega, Federico ;
Rubio Garcia, Rafael ;
Hervas Gomez, Rafael ;
Cepeda Gonzalez, Concepcion ;
Ramon Costa Perez-Herrero, Jose .
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA, 2007, 25 (07) :441-445
[9]  
*I NAC EST, 2007, AV PADR MUN 1 EN 200
[10]   Predictors identified for losses to follow-up among HIV-seropositive patients [J].
Lanoy, Emilie ;
Mary-Krause, Murielle ;
Tattevin, Pierre ;
Dray-Spira, Rosemary ;
Duvivier, Claudine ;
Fischer, Patricia ;
Obadia, Yolande ;
Lert, France ;
Costagliola, Dominique .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2006, 59 (08) :829-835