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Study Identifies Distinct Characteristics of Patients Presenting With Late Stage HIV: Presented at IAS By Ed Susman CAPE TOWN, South Africa -- July 24, 2009 -- A group of German physicians compared late-presenting HIV cases, usually patients who have an AIDS-defining illness as their first diagnosis, with non-late presenters and discovered significant differences in the demographics of the patients. The findings were discussed at a July 20 poster presentation at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention. “Late presenters tend to be older, they are more often women, and they are from high-prevalence countries,” said lead author Jurgen van Lunzen, MD, Universitatskilinkum Eppendorf, Hamburg, Germany. “Prevention and testing strategies should try to take this into account.” Dr. van Lunzen and colleagues reported that 13 of the 54 (24%) late presenters were women whereas 26 of 251 (10%) of the non-late presenters were women (P < .01). He said that 10 (19%) of the late presenters were native to areas of high prevalence -- countries where more than 1% of the population is infected with HIV -- compared with 18 (7%) of non-late presenters (P < .01) The late presenters also had an older mean age: 40.9 years compared with 38.1 years for the non-late presenters (P = .034). Women tend to present at later stages of disease, mainly because clinicians may not be thinking of HIV when they are being examined initially. “We basically found almost the same experience among late presenters,” said Gerrit Schreij, MD, University of Maastricht, Maastricht, the Netherlands, who commented on the studies but did not participate in the study being reported. “When we see women and older individuals in our area, which is much the same as western Germany, we just don’t think immediately about HIV or AIDS,” he said. “Consequently, our diagnosis of the illness in these people is delayed.” The researchers reviewed data collected among patients in the extended German Truvada cohort -- patients receiving a fixed-dose combination of emtricitabine and tenofovir. Despite the late presentation of infection, Dr. van Lunzen said that treatment with combination therapy that included the combination pill plus either a non-nucleoside reverse transcriptase or a protease inhibitor succeeded in reducing HIV to undetectable levels similarly to what was achieved among non-late presenters. In fact, in his study, 70% of the late presenters were able to achieve undetectable levels of virus using the 50-copies/mL assay compared with 67% of the non-late presenters. However, at 48 weeks, mean CD4 cell counts lagged in the late presenters. The baseline CD4 cell count was 64 cells/mm3 in the late presenters compared with 237 cells/mm3 in the non-late presenters. By week 48, the late presenters registered a CD4 cell count of 271 cells/mm3 compared with 408 cells/mm3 for the non-late presenter. In addition, during the 48-week treatment period, 22% (12) of the late presenters experienced an AIDS-defining event compared with 7.6% (19) of the non-late presenters (P < .05). Dr. van Lunzen noted that late presenters were more likely to receive protease inhibitor-based treatment (96%) than non-late presenters (50%). [Presentation title: Late Presentation Is Frequent in the Elderly, in Female and in Patients From High Prevalence Countries in a German Outpatient Cohort. Abstract MOPEB061] E-mail this page to a friend or colleague! To print, use this version