Epidemiological and clinical characteristics of HIV-infected persons entering care in Croatia in the period 2007-2015

master's thesis

• Author: Alexandra Helene Denise Yvonne Laval
• Mentor: Josip Begovac (mentor)
• Committee member: Davorka Lukas (predsjednik povjerenstva)
• Committee member: Goran Tešović (član povjerenstva)
• Committee member: Josip Begovac (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2016-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Epidemiology

Abstract

Background: In Croatia, all people living with HIV receive care at one treatment center, at
the University Hospital for Infectious Diseases (UHID) in Zagreb.
Objective: To describe the main characteristics of HIV infected persons who entered care at
UHID in the period 2007-2015. We also assessed factors associated with late presentation to
care. ----- Methods: We extracted data from the electronic HIV-database at UHID for all patients who
entered care in the period 2007-2015. The following data were analysed: already diagnosed
in another country, age, gender, place of living, risk group, CDC classification and CD4 cell
count at entry into care. In the analysis of factors related to late presentation we included
only adults who were not in care elsewhere before entering care at UHID and who acquired
HIV by sexual transmission. Late presentation of care was defined as having < 350 CD4
cells/mm3 at presentation and logistic regression was done to assess factors related to late
presentation. ----- Results:. A total of 731 persons entered care at UHID in the period 2007-2015. Of those 731
persons 44 were coming from abroad and were already treated elsewhere. Of 687 who
entered care for the first time 682 were adults (> 18 years). The number of HIV positive
persons included in care for the first time more than doubled from 2007 (n=54) to 2015
(n=116). 39% of patients were in the age group 30 to 39 years, < 1% were younger than 18
years and 10% were older than 50 years. The proportion of persons living in Zagreb or
Zagreb county ranged from 24% to 47% per calendar year. The main mode of transmission
was sex between men (MSM; overall: 80%). The median CD4 cell count at entry into care
was lowest in 2011 (209 per mm3), however, since then it has increased and reached 355
per mm3 in 2015. The proportion of persons presenting with clinical AIDS was highest in
2010 and 2011 (28.4%), and lowest in 2015 (15.5%). On multivariable analysis, the following
factors were associated with late presentation to care (n=653): not living in Zagreb -
heterosexual mode of transmission and older age. ----- Conclusion: The number of HIV infected persons entering care in the period 2007-2015
increased substantialy. The dominant mode of transmission is sex between men. Late
presentation to care is still common. Our data suggest that there is an increasing need for
prevention efforts that focus on MSM. To improve earlier presentation to care there needs to
be more focus on persons living outside Zagreb and older heterosexuals.

• Keywords: HIV; AIDS; Croatia; epidemiology
• Language: english
• URN:NBN: urn:nbn:hr:105:202091
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-30 09:49:51