Diagnóstico tardío de VIH: diferencias entre nativos y migrantes internacionales. Estudio observacional en un hospital de la Ciudad Autónoma de Buenos Aires
Palabras clave:
VIH, diagnóstico tardío, migrantes, población vulnerable
Resumen
Introducción: El diagnóstico tardío de la infección por VIH y el acceso de los pacientes al sistema de salud con enfermedad avanzada afectan negativamente los beneficios individuales y colectivos del tratamiento antirretroviral. A nivel mundial existe una alta prevalencia de diagnóstico tardío especialmente en poblaciones vulnerables como los migrantes.
Objetivos: medir la prevalencia de diagnóstico tardío de infección por VIH entre migrantes internacionales y compararla con la de los argentinos.
Material y métodos: estudio retrospectivo, observacional, de personas mayores de 16 años, asistidas en el hospital General de Agudos Donación Francisco Santojanni, que hubieran recibido diagnóstico de infección por VIH entre 01-01-2018 y 31-12-2021. Se determinó la mediana de recuento de CD4 basal y la prevalencia de diagnóstico tardío. Aplicamos la prueba de la suma de rangos de Wilcoxon para la variable contínua y la prueba de Fisher para comparar proporciones.
Resultados: Incluimos 180 personas (50 migrantes, 130 argentinos). Los migrantes presentaron un nivel basal de linfocitos CD4 significativamente menor [Mediana (RIC 25-75) 225 (76-394) vs 318 (139-520); p=0,046], mayor tasa de presentación tardía [72% vs 55,4%; RR 1,3 (IC95 1,03-1,64); p=0,04] y con criterios de sida [46% vs 33,1%; RR 1,39 (IC95 0,94-2,05); p=0,12] y una menor proporción de diagnósticos en etapa temprana [12% vs 27,7%; RR 0,43 (IC95 0,19-0,96); p=0,03].
Conclusiones: los migrantes internacionales accedieron al diagnóstico en peor estado clínico que los argentinos. Conocer este dato es imprescindible para elaborar políticas tendientes a mejorar el acceso al diagnóstico de esta población vulnerable.
Descargas
La descarga de datos todavía no está disponible.
Citas
1) May M, Gompels M, Delpech V, Porter K, Post F, Johnson M, et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ. 2011 Oct 11; 343: d6016. https://www.bmj.com/content/343/bmj.d6016
2) Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006 Jun 26; 20 (10):1447-50. https://pubmed.ncbi.nlm.nih.gov/16791020/
3) Girardi E, Sabin CA, d’Arminio Monforte A. Late Diagnosis of HIV Infection: Epidemiological Features, Consequences and Strategies to Encourage Earlier Testing. J Acquir Immune Defic Syndr. 2007 Sep; 46 Suppl 1:S3-8. https://pubmed.ncbi.nlm.nih.gov/17713423/
4) https://www.paho.org/en/topics/hivaids (acceso 8 de enero de 2023).
5) Dirección de Respuesta al VIH, ITS, Hepatitis Virales y Tuberculosis, Ministerio de Salud de la Nación Argentina, 2022. Boletín N° 39 Respuesta al VIH y las ITS en la Argentina. https://bancos.salud.gob.ar/recurso/boletin-ndeg-39-respuesta-al-vih-y-las-its-en-la-argentina
6) Collins S, Namiba A, Sparrowhawk A, Strachan S, Thompson M, Nakamura H. Late diagnosis of HIV in 2022: Why so little change? HIV Med. 2022 Dec; 23 (11): 1118-1126. https://pubmed.ncbi.nlm.nih.gov/36397250/
7) Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report 2021;26 (No. 2). http://www.cdc.gov/hiv/library/reports/ hiv-surveillance.html. Published May 2021. Acceso 09-01-2023.
8) Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KKV, Rodriguez-Cruz A, et al. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS. 2021 Aug; 35 (8): 288-307. https://pubmed.ncbi.nlm.nih.gov/34375137/
9) Borchmann O, Haukali Omland L, Gerstoft J, Schade Larsen C, Somuncu Johansen I, Lunding S, Jensen J, Obel N, and Eg HansenAB. Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020. Euro Surveill. 2022 Jul; 27 (30): 2100809. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336168/
10) Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health. 2013 Dec; 23 (6): 1039-45. https://pubmed.ncbi.nlm.nih.gov/23002238/
11) Ross J, Cunningham CO, Hanna DB. HIV outcomes among migrants from low-and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis. 2018 Feb; 31 (1): 25-32. https://pubmed.ncbi.nlm.nih.gov/29095720/
12) Organización Panamericana de la Salud, Organización Mundial de la Salud. Documento de orientación sobre migración y salud. Documentos de Orientación sobre Migración y Salud. https://www.paho.org/es/documentos/documento-orientacion-sobre-migracion-salud (acceso 17 enero de 2023).
13) Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al and European Late Presenter Consensus Working Group. Late presentation of HIV infection: a consensus definition. HIV Med. 2011 Jan; 12 (1): 61-4. https://pubmed.ncbi.nlm.nih.gov/20561080/
14) Le Messurier J, Traversy G, Varsaneux O, Weekes M, Avey MT, Niragira O, et al. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. CMAJ. 2018 Nov 19; 190 (46): E1350-60. https://pubmed.ncbi.nlm.nih.gov/30455270/
15) Gorbach, PM, Drumright, LN, Daar, ES. Transmission behaviors of recently HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2006 May; 42 (1): 80-5. https://pubmed.ncbi.nlm.nih.gov/16763494/
16) Fleishman JA, Yehia BR, Moore RD, Gebo KA, and HIV Research Network. The Economic Burden of Late Entry Into Medical Care for Patients With HIV Infection. Med Care. 2010 Dec; 48 (12): 1071-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022268/
17) Shehan D, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, et al. Individual and neighborhood determinants of late HIV diagnosis among Latinos, Florida, 2007-2011. J Immigr Minor Health. 2017 Aug; 19 (4): 825-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083229/
18) Miranda MNS, Pingarilho M, Pimentel V, Martins RO, Vandamme AM, Bobkova M, et al, Determinants of HIV-1 late presentation in patients followed in Europe. Pathogens. 2021 Jul 2; 10 (7): 835. https://pubmed.ncbi.nlm.nih.gov/34357985/
19) Marukutira T, Gunaratnam P, Douglass C, Jamil MS, McGregor S, Guy R, et al. Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study. Medicine (Baltimore). 2020 Feb; 99 (8): e19289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034696/
20) Prost A, Elford J, Imrie J, Petticrew M, Hart GJ. Social, behavioural, and intervention research among people of sub-saharan African origin living with HIV in the UK and Europe: literature review and recommendations for intervention. AIDS Behav. 2008 Mar; 12 (2): 170-94. https://psycnet.apa.org/record/2008-05720-002
21) Demeke HB, Johnson AS, Zhu H, Gant Z, Duffus WA, Dean HD. HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016. Int J Environ Res Public Health. 2018 Oct 30; 15 (11): 2404. https://pubmed.ncbi.nlm.nih.gov/30380715/
22) Chen NE, Gallant JE, Page KR. A systematic review of HIV/AIDS survival and delayed diagnosis among Hispanics in the United States. J Immigr Minor Health. 2012 Feb; 14 (1): 65-81. https://pubmed.ncbi.nlm.nih.gov/21773882/
23) Villanueva Pabon LP, Alfaro Fierro VF, Lagunas Pizarro MA, Horna-Campos OJ. Caracterización epidemiológica de los nuevos diagnósticos de infección por virus de inmunodeficiencia humana en Chile período 2010-2019. Rev Chilena Infectol 2022; 39: 405-12. https://www.revinf.cl/index.php/revinf/article/view/1295
24) Floersheim C, Musso S, Eubanks A, Douine M, Spire B, Sagaon-Teyssier L, et al. What can lead to late diagnosis of HIV in an illegal gold mining environment? A qualitative study at the French Guiana’s border with Brazil. BMJ Open. 2022 Sep 5; 12 (9): e061237. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445782/
25) Huerta-Vera GS, Amarista MA, Mejía FA, Graña AB , Gonzalez-Lagos EV, Gotuzzo E. Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Perú. Int J STD AIDS. 2021 Oct; 32 (12): 1157-64. https://pubmed.ncbi.nlm.nih.gov/34156882/
26) World Health Organization. HIV/AIDS surveillance in Europe 2021. https://www.ecdc.europa.eu/sites/default/files/documents/2022-Annual_HIV_Report_final.pdf. (acceso 17 enero de 2023).
2) Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006 Jun 26; 20 (10):1447-50. https://pubmed.ncbi.nlm.nih.gov/16791020/
3) Girardi E, Sabin CA, d’Arminio Monforte A. Late Diagnosis of HIV Infection: Epidemiological Features, Consequences and Strategies to Encourage Earlier Testing. J Acquir Immune Defic Syndr. 2007 Sep; 46 Suppl 1:S3-8. https://pubmed.ncbi.nlm.nih.gov/17713423/
4) https://www.paho.org/en/topics/hivaids (acceso 8 de enero de 2023).
5) Dirección de Respuesta al VIH, ITS, Hepatitis Virales y Tuberculosis, Ministerio de Salud de la Nación Argentina, 2022. Boletín N° 39 Respuesta al VIH y las ITS en la Argentina. https://bancos.salud.gob.ar/recurso/boletin-ndeg-39-respuesta-al-vih-y-las-its-en-la-argentina
6) Collins S, Namiba A, Sparrowhawk A, Strachan S, Thompson M, Nakamura H. Late diagnosis of HIV in 2022: Why so little change? HIV Med. 2022 Dec; 23 (11): 1118-1126. https://pubmed.ncbi.nlm.nih.gov/36397250/
7) Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report 2021;26 (No. 2). http://www.cdc.gov/hiv/library/reports/ hiv-surveillance.html. Published May 2021. Acceso 09-01-2023.
8) Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KKV, Rodriguez-Cruz A, et al. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS. 2021 Aug; 35 (8): 288-307. https://pubmed.ncbi.nlm.nih.gov/34375137/
9) Borchmann O, Haukali Omland L, Gerstoft J, Schade Larsen C, Somuncu Johansen I, Lunding S, Jensen J, Obel N, and Eg HansenAB. Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020. Euro Surveill. 2022 Jul; 27 (30): 2100809. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336168/
10) Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health. 2013 Dec; 23 (6): 1039-45. https://pubmed.ncbi.nlm.nih.gov/23002238/
11) Ross J, Cunningham CO, Hanna DB. HIV outcomes among migrants from low-and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis. 2018 Feb; 31 (1): 25-32. https://pubmed.ncbi.nlm.nih.gov/29095720/
12) Organización Panamericana de la Salud, Organización Mundial de la Salud. Documento de orientación sobre migración y salud. Documentos de Orientación sobre Migración y Salud. https://www.paho.org/es/documentos/documento-orientacion-sobre-migracion-salud (acceso 17 enero de 2023).
13) Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al and European Late Presenter Consensus Working Group. Late presentation of HIV infection: a consensus definition. HIV Med. 2011 Jan; 12 (1): 61-4. https://pubmed.ncbi.nlm.nih.gov/20561080/
14) Le Messurier J, Traversy G, Varsaneux O, Weekes M, Avey MT, Niragira O, et al. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. CMAJ. 2018 Nov 19; 190 (46): E1350-60. https://pubmed.ncbi.nlm.nih.gov/30455270/
15) Gorbach, PM, Drumright, LN, Daar, ES. Transmission behaviors of recently HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2006 May; 42 (1): 80-5. https://pubmed.ncbi.nlm.nih.gov/16763494/
16) Fleishman JA, Yehia BR, Moore RD, Gebo KA, and HIV Research Network. The Economic Burden of Late Entry Into Medical Care for Patients With HIV Infection. Med Care. 2010 Dec; 48 (12): 1071-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022268/
17) Shehan D, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, et al. Individual and neighborhood determinants of late HIV diagnosis among Latinos, Florida, 2007-2011. J Immigr Minor Health. 2017 Aug; 19 (4): 825-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083229/
18) Miranda MNS, Pingarilho M, Pimentel V, Martins RO, Vandamme AM, Bobkova M, et al, Determinants of HIV-1 late presentation in patients followed in Europe. Pathogens. 2021 Jul 2; 10 (7): 835. https://pubmed.ncbi.nlm.nih.gov/34357985/
19) Marukutira T, Gunaratnam P, Douglass C, Jamil MS, McGregor S, Guy R, et al. Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study. Medicine (Baltimore). 2020 Feb; 99 (8): e19289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034696/
20) Prost A, Elford J, Imrie J, Petticrew M, Hart GJ. Social, behavioural, and intervention research among people of sub-saharan African origin living with HIV in the UK and Europe: literature review and recommendations for intervention. AIDS Behav. 2008 Mar; 12 (2): 170-94. https://psycnet.apa.org/record/2008-05720-002
21) Demeke HB, Johnson AS, Zhu H, Gant Z, Duffus WA, Dean HD. HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016. Int J Environ Res Public Health. 2018 Oct 30; 15 (11): 2404. https://pubmed.ncbi.nlm.nih.gov/30380715/
22) Chen NE, Gallant JE, Page KR. A systematic review of HIV/AIDS survival and delayed diagnosis among Hispanics in the United States. J Immigr Minor Health. 2012 Feb; 14 (1): 65-81. https://pubmed.ncbi.nlm.nih.gov/21773882/
23) Villanueva Pabon LP, Alfaro Fierro VF, Lagunas Pizarro MA, Horna-Campos OJ. Caracterización epidemiológica de los nuevos diagnósticos de infección por virus de inmunodeficiencia humana en Chile período 2010-2019. Rev Chilena Infectol 2022; 39: 405-12. https://www.revinf.cl/index.php/revinf/article/view/1295
24) Floersheim C, Musso S, Eubanks A, Douine M, Spire B, Sagaon-Teyssier L, et al. What can lead to late diagnosis of HIV in an illegal gold mining environment? A qualitative study at the French Guiana’s border with Brazil. BMJ Open. 2022 Sep 5; 12 (9): e061237. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445782/
25) Huerta-Vera GS, Amarista MA, Mejía FA, Graña AB , Gonzalez-Lagos EV, Gotuzzo E. Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Perú. Int J STD AIDS. 2021 Oct; 32 (12): 1157-64. https://pubmed.ncbi.nlm.nih.gov/34156882/
26) World Health Organization. HIV/AIDS surveillance in Europe 2021. https://www.ecdc.europa.eu/sites/default/files/documents/2022-Annual_HIV_Report_final.pdf. (acceso 17 enero de 2023).
Publicado
2023-11-20
Cómo citar
Bottaro, E. G., Scapellato, P. G., Lovera, M., & Barrera, V. (2023). Diagnóstico tardío de VIH: diferencias entre nativos y migrantes internacionales. Estudio observacional en un hospital de la Ciudad Autónoma de Buenos Aires. Actualizaciones En Sida E Infectología, 31(113). https://doi.org/10.52226/revista.v31i113.192
Sección
Comunicación breve
