Temporal trend of the proportion of patients presenting with advanced HIV in French Guiana: stuck on the asymptote?

(2018) 11:831 Nacher et al. BMC Res Notes https://doi.org/10.1186/s13104-018-3944-y BMC Research Notes Open Access RESEARCH NOTE Temporal trend of the proportion of patients presenting with advanced HIV in French Guiana: stuck on the asymptote? Mathieu Nacher1,2* , Florence Huber2, Leila Adriouch2, Félix Djossou3, Antoine Adenis1 and Pierre Couppié4 Abstract Objective: In French Guiana, the French territory with the most preoccupying HIV epidemic, there have been great efforts to intensify and diversify HIV testing strategies. The aim of the present study was to review the temporal trends of patients diagnosed with advanced HIV disease in French Guiana. Data trends from the HIV cohort of French Guiana between 1996 and 2016 were thus analyzed. Results: The proportion of patients diagnosed with advanced disease did not decline over time. Males had lower CD4 counts at the time of diagnosis and there was a plateau for both males (around 40%) and females (around 25%) with no apparent reduction of the proportion of advanced disease. Older age groups and migrants presented more often with advanced disease. By contrast, the proportion of patients diagnosed with stage B and C disease declined over time and the CD4 count at antiretroviral initiation and the CD4 nadir increased over time. Despite some progress, the group of patients with advanced disease reached a plateau around 30% suggesting this particular group still has epidemiological importance in driving the epidemic and in fueling morbidity and mortality, and thus remains a challenge for testing strategies. Keywords: HIV, Advanced disease, CD4, AIDS, French Guiana Introduction Since the first description of AIDS in 1981, the HIV epidemic has generated unprecedented progress in the development of effective drugs and therapeutic strategies. If every single patient was effectively treated, the ambition of a world without HIV would even be theoretically possible [1]. However, in real life, those who are infected and undiagnosed contribute disproportionally to the epidemic dynamics. A major goal is thus to continually reduce the proportion of undiagnosed HIV infections and to treat all HIV-infected patients in order to reduce morbidity and transmission. French Guiana is the French territory with the most preoccupying HIV epidemic [2]. This French territory has access to all the newest antiretroviral drugs, PreP, *Correspondence: 1 Centre d’Investigation Clinique, CIC Inserm 1424, Cayenne Hospital, rue des Flamboyant, BP 6006, 97306 Cayenne Cedex, French Guiana Full list of author information is available at the end of the article residence permits and free universal health care for all HIV patients. About 75% of persons living with HIV are foreign nationals. The epidemic is driven by sex work, crack cocaine use, and multiple concurrent sexual partnerships [2]. The prevalence among pregnant women has been over 1% for 2 decades. In French Guiana, males, older age groups and migrants were tested later on average than other groups [3]. In the past 5 years, there has been a great diversification of HIV testing strategies with ELISA lab testing, testing in emergency services, rapid testing at private practitioners, community based testing, mobile testing centers, and self testing [4]. The number of tests performed in French Guiana is also very high, more than twice of what is performed in Mainland France (205 tests per 1000 inhabitants versus 81 tests per 1000 inhabitants, respectively) [5]. Given the great efforts put into this strategic objective, the aim of the present study was to review the temporal © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nacher et al. BMC Res Notes (2018) 11:831 Page 2 of 6 trends of patients diagnosed with advanced HIV disease [6] in French Guiana. homoscedasticity. Data was analyzed using STATA 13 software (College Station, Texas, USA). Main text Ethical and regulatory aspects Methods Patients included in the FHDH give written informed consent for the use of their data for research and publication of research results. Their identity is encrypted before sending the data to the Institut National de la Recherche Médicale (INSERM), which centralizes data from Regional Coordination for the fight against HIV (COREVIH) throughout France. This cohort has been approved since November 27th 1991 by the Commission Nationale Informatique et Libertés (CNIL) and has led to numerous international scientific publications. Data on HIV patients in French Guiana has been available since 1989. Clinical, biological and epidemiological data was entered by specific trained research technicians in the DMI2 government software until 2008, and in eNADIS/DATAIDS since then, as described elsewhere [7, 8]. The data was aggregated by year. Given the small number of patients in the early years, this led to large fluctuations between years. Therefore, to avoid this “noise” we limited our analysis to the 1996–2016 period. This allowed us to obtain, for each year, the proportion of patients by CD4 count strata at the time of diagnosis, by CDC stage, by CD4 count strata at the time of treatment initiation, and the nadir CD4 count. This was stratified by sex, age group, and foreign/French status. Statistical analysis The main definition of “advanced disease” used was having CD4 counts < 200/mm3. To be more thorough we also looked at the CDC stage, the CD4 nadir, the CD4 count at the time of treatment initiation. The data was plotted. In order to test for statistical trend in the curves we used regression models regressing the dependent variable on time, in practice testing the hypothesis that the slope in time was 0. The dependent variables were normalized when necessary to ensure Fig. 1 CD4 count at the time of diagnosis by year, French Guiana Results Overall, between 1996 and 2016, there were 1965 patients analyzed (1053 females and 912 males). The transmission route was heterosexual contact for 86.8%, homosexual or bisexual contact for 3.7%, mother to child for 2.2% unknown for 6.6% and other transmission modes were < 1%. Figure 1 shows that the proportion of patients diagnosed with advanced disease (CD4 > 200/mm3) did not decline over time. The linear regression model confirmed that there was no relation between time and the proportion of patients diagnosed with less than 200 CD4 lymphocytes per mm3 (Beta coefficient = 0.09, p = 0.75). Similarly those with less than 50 (...truncated)