In Guatemala study, illnesses indicating AIDS were already present in about fourth of patients newly diagnosed with HIV

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At Guatemala’s largest HIV clinic, researchers took a retrospective study of current patient records. One in four patients, they found, had an illness indicating advanced progression of the virus at the time they were diagnosed, increasing their risks of other diseases and death, while increasing the costs of their care.

With plans now turning to shift focused United States-led efforts to a limited set of countries, the 2016 study reflects a vicious and ongoing circle in health care settings with limited resources. While rates of illnesses indicating AIDS are found in as many as about 15 percent of patients diagnosed with HIV in the United States and in Western European countries, the authors note, the rates are generally markedly higher in less economically developed countries.

About 0.5 percent of adults were estimated to be living with HIV in Guatemala in 2016, the authors of a report on the study wrote, and the virus is a significant cause of both illnesses and deaths there. While antiretroviral treatment for HIV became accessible through Guatemala public health programs in 2000, the authors note that death rates from HIV continued to rise, from a little more than 13 per 100,000 people in 1990 to 22 per 100,000 people in 2012, with many not getting diagnosed or treated until their illnesses were advanced.

Sifting through the records of more than 3000 patients currently visiting the HIV clinic at Roosevelt Hospital in Guatemala City for routine care, researchers found those who already had illnesses indicating advanced HIV at the time they were diagnosed with the virus were likelier to be male. They also were likelier to have higher viral loads than other patients at the time of diagnosis, making transmission of the virus likelier. About 80 percent had immune cell counts under 200, making them more vulnerable to opportunistic infections.

Tuberculosis was the most common co-infection among those patients, whether they were living in a rural or urban environment when diagnosed, followed by a form of pneumonia caused by a fungus that doesn’t commonly cause illness in health people. HIV diagnoses that were accompanied by diagnoses of histoplasmosis, another lung infection caused fungal spores found in bat and bird droppings, increased over time, reflecting availability of improved diagnostic tools. The authors note that limited access to diagnostic tools may continue to lead to an underestimation of the prevalence of histoplasmosis among people with HIV in Guatemala, particularly in rural areas.

The report of the study, led by Samuel Reinhardt of Washington University School of Medicine, was published in Open Forum Infectious Diseases.

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