Patients re-engaging with HIV care in Guatemala: Prioritizing CD4 counting and screening for histoplasmosis and tuberculosis

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2025-02-17 DOI:10.1111/hiv.70000

Narda Medina, Ana Alastruey-Izquierdo, Oscar Bonilla, Danicela Mercado, Eduardo Arathoon, Juan Luis Rodriguez-Tudela

{"title":"Patients re-engaging with HIV care in Guatemala: Prioritizing CD4 counting and screening for histoplasmosis and tuberculosis","authors":"Narda Medina, Ana Alastruey-Izquierdo, Oscar Bonilla, Danicela Mercado, Eduardo Arathoon, Juan Luis Rodriguez-Tudela","doi":"10.1111/hiv.70000","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re-engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re-engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among patients re-engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re-engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re-engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Patients re-engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS-related mortality.</p>\n </section>\n </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 5","pages":"701-708"},"PeriodicalIF":2.8000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIV Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hiv.70000","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re-engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.

Methods

A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re-engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.

Results

Among patients re-engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re-engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re-engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.

Conclusion

Patients re-engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS-related mortality.

查看原文本刊更多论文

危地马拉患者重新接受艾滋病毒治疗：优先考虑CD4计数和组织浆菌病和结核病筛查。

背景：停止抗逆转录病毒治疗（ART）显著促进了晚期HIV疾病（AHD）和机会性感染的发展。本研究分析了中断抗逆转录病毒治疗后重新接受治疗的患者的数据，并将该队列与新诊断的艾滋病毒患者进行了比较，重点关注结核病和组织胞浆菌病的负担。方法：2017年在危地马拉实施机会性感染诊断包，包括结核病和组织胞浆菌病。从2017年到2019年，我们在13家医疗机构招募了1379名重新参与护理的成年人和3412名新诊断的艾滋病毒患者。数据收集包括人口统计信息、实验室检测结果和患者预后。结果：在重新接受治疗的患者中，54%（903例中有491例）患有AHD，与新诊断患者的50.1%（2692例中有1349例）相当。在重新参与的队列中，34.5%的人没有接受CD4检测，而新诊断组的这一比例为21.1%。这突出表明，在通过客观、公正的检测来评估晚期艾滋病毒状态方面存在重大差距。在重新接受治疗的患者中，无论免疫状况如何，结核和组织浆菌病的发病率分别为9.7%和8.3%。这表明该组机会性感染的负担很高，新诊断的患者结核病和组织浆菌病的发病率相似，分别为8.5%和8.3%。结论：患者重新参与护理应遵循与新诊断患者相似的流程。迫切需要进行常规和立即的CD4检测，以确定AHD并实施建议的综合诊断和护理方案。早期发现和有针对性的干预对于降低艾滋病相关死亡率至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.