Ethnic differences in stage of presentation of adults newly diagnosed with HIV‐1 infection in south London

HIV Medicine - Tập 6 Số 2 - Trang 59-65 - 2005
A. E. Boyd1, Shahed Murad1, Siobhan O’Shea2, Annemiek de Ruiter2, Ceri Watson3, Philippa Easterbrook1
1Department of HIV/Genitourinary Medicine, King's College Hospital, London,
2Department of Infection, Guy's and St Thomas' Hospital Trust, London, and
3Department of Genitourinary Medicine St Thomas' Hospital, London, UK

Tóm tắt

ObjectivesTo establish whether there were ethnic differences in demographic characteristics, the stage at HIV diagnosis and reasons for and location of HIV testing between 1998 and 2000 in a large ethnically diverse HIV‐1‐infected clinic population in south London in the era of highly active antiretroviral therapy.MethodsA retrospective review was carried out of all persons >18 years old attending King's College Hospital with a first positive HIV‐1 test between 1 January 1998 and 31 October 2000, and of a random sample of patients attending St Thomas' hospital with a first positive HIV‐1 test in the same period. Demographic data, details of reasons for and site of HIV test, clinical stage, CD4 lymphocyte count and HIV‐1 viral load at HIV diagnosis were abstracted from the local database and medical records. Comparisons were made according to ethnic group (white, black African and black Caribbean) and over time (1998, 1999 and 2000).ResultsOf the 494 patients with new HIV‐1 diagnoses between January 1998 and December 2000, 179 (36.2%) were white, 270 (54.7%) were black African and 45 (9.1%) were black Caribbean. There were significant differences across the ethnic groups in HIV risk group, reasons for and site of HIV testing, and clinical and CD4 stage at diagnosis. Among whites, 72.6% were men who had sex with men, 3.4% injecting drug users and 21.2% heterosexuals, compared to 2.2%, 0.4% and 93.3% among black Africans, and 28.9%, 0% and 68.9% among black Caribbeans (P<0.001). Black Africans were more likely to present with an AIDS diagnosis (21.3%) and a lower CD4 cell count [223 cells/μL; interquartile range (IQR) 88–348] compared to both whites (9.9%; 358 cells/μL; IQR 151–508) and black Caribbeans (17.9%; 294 cells/μL; IQR 113–380), who were intermediate between whites and black Africans in their stage of presentation. There was a statistically nonsignificant trend with time, between 1998 and 2000, towards earlier diagnosis based on the CD4 cell count in whites (323 and 403 cells/μL) and black Caribbeans (232 and 333 cells/μL), but a later diagnosis in black Africans (233 and 175 cells/μL). The majority of black Africans were HIV‐tested as a result of suggestive symptoms or antenatal screening (58.4%) rather than because of perceived risk (40.5%), in contrast to the situation in whites (24.1% vs. 71.7%, respectively) or black Caribbeans (34.5% vs. 65.5%, respectively) (P<0.001). We found no significant differences across ethnic groups in age, HIV‐1 viral load or year of HIV diagnosis.ConclusionsBlack Africans continue to present with more advanced HIV disease than whites or black Caribbeans, with no evidence of any trend towards earlier diagnosis. Future educational campaigns designed to promote the uptake of HIV testing among black Africans and black Caribbeans will need to address the multiple barriers to testing, including misperception of risk, stigma and ready access to testing.

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Tài liệu tham khảo

The UK Collaborative Group for HIV and STI Surveillance Focus on Prevention.HIV and other sexually transmitted infections in the United Kingdom in 2003. London: Health Protection Agency Centre for Infections 7 November 2004.

Dougan S, 2004, Black Caribbean adults with HIV in England, Wales and Northern Ireland, an emerging epidemic?, 80, 18

10.1097/00002030-200003310-00012

Adhieh‐Grant L, 2003, When to initiate highly active antiretroviral therapy, a cohort approach, 157, 738

10.1001/jama.286.20.2568

Egger M, 2002, Progression of HIV‐1 infected patients starting highly active antiretroviral therapy, a collaborative analysis of prospective studies, 360, 119

O'Farrell N, 1995, AIDS in Africans living in London, Genitourin Med, 71, 358

Low N, 1996, AIDS survival and progression in black Africans living in south London, 1986–1994, Genitourin Med, 72, 12

10.1136/sti.76.3.215

10.1097/00002030-200112070-00015

10.1046/j.1468-1293.2002.00103.x

EasterbrookPJ ChadbournT SalamiPet al.Impact of a London HIV Testing Awareness Media Campaign. International AIDS Conference. Barcelona July 2002 [Abstract TuPeD4994].

Fenton KA, 2002, HIV testing and high risk sexual behaviour among London's migrant African communities, a participatory research study, 78, 241

10.1136/sti.78.1.37

10.1016/S0277-9536(99)00220-8

ThevarajanI MvereM MuradSet al.Social needs of HIV infected patients in South East London.9th European AIDS Conference (EACS). Warsaw December 2003 [Abstract 19.1/7].

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HIV Medicine

Tập 6 Số 2

59-65

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