PMID- 17926639
OWN - NLM
STAT- MEDLINE
DCOM- 20071206
LR  - 20071010
IS  - 1359-6535 (Print)
IS  - 1359-6535 (Linking)
VI  - 12
IP  - 6
DP  - 2007
TI  - Late presentation of HIV-infected individuals.
PG  - 841-51
AB  - Late presentation remains a major concern despite the dramatically improved 
      prognosis realized by ART. We define a first presentation for HIV care during the 
      course of HIV infection as 'late' if an AIDS-defining opportunistic disease is 
      apparent, or if CD4+ T-cells are <200/microl. In the Western world, approximately 
      10 and 30% of HIV-infected individuals still present with CD4+ T-cells <50 and 
      <200/microl, respectively; estimates are substantially higher for developing 
      countries. Diagnosis and treatment of opportunistic diseases and intense 
      supportive in-hospital care take precedence over ART. Benefits of starting ART 
      without delay, that is, when opportunistic diseases are still active, include 
      faster resolution of opportunistic diseases and a decreased risk of recurrence. 
      The downside of starting ART without delay could include toxicity, drug 
      interactions and immune reconstitution inflammatory syndrome (IRIS). Among 
      asymptomatic or oligosymptomatic individuals presenting late, where ART and 
      primary prophylaxis are initiated, approximately 10-20% will become symptomatic 
      from drug toxicity or undiagnosed opportunistic complications, including IRIS, 
      which require appropriate therapies. In this review we describe late presentation 
      to HIV care, the scale of the problem, the evaluation of a late-presenting 
      patient and challenges associated with initiation of potent antiretroviral 
      therapy (ART) in the setting of acute opportunistic infections and other 
      comorbidities.
FAU - Battegay, Manuel
AU  - Battegay M
AD  - Division of Infectious Diseases Et Hospital Epidemiology, University Hospital 
      Basel, Switzerland. mbattegay@uhbs.ch
FAU - Fluckiger, Ursula
AU  - Fluckiger U
FAU - Hirschel, Bernard
AU  - Hirschel B
FAU - Furrer, Hansjakob
AU  - Furrer H
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Antivir Ther
JT  - Antiviral therapy
JID - 9815705
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/complications/*prevention & control
MH  - Anti-HIV Agents/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - Diagnosis, Differential
MH  - HIV Infections/diagnosis/*drug therapy/immunology/virology
MH  - Humans
RF  - 91
EDAT- 2007/10/12 09:00
MHDA- 2007/12/07 09:00
CRDT- 2007/10/12 09:00
PHST- 2007/10/12 09:00 [pubmed]
PHST- 2007/12/07 09:00 [medline]
PHST- 2007/10/12 09:00 [entrez]
PST - ppublish
SO  - Antivir Ther. 2007;12(6):841-51.