AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan
Abstract Background Although Taiwan has implemented several important interventions for various HIV-at-risk populations to combat the HIV epidemic, little is known regarding AIDS incidence at presentation and during follow-up among the various HIV-at-risk populations in Taiwan. A better understandin...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-018-5500-z |
| _version_ | 1811311524899192832 |
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| author | Chun-Yuan Lee I-An Jen Yu-Ching Lan Yung-Feng Yen Pei-Hung Chuang Marcelo Chen Yun Lee Yi-Ming A. Chen |
| author_facet | Chun-Yuan Lee I-An Jen Yu-Ching Lan Yung-Feng Yen Pei-Hung Chuang Marcelo Chen Yun Lee Yi-Ming A. Chen |
| author_sort | Chun-Yuan Lee |
| collection | DOAJ |
| description | Abstract Background Although Taiwan has implemented several important interventions for various HIV-at-risk populations to combat the HIV epidemic, little is known regarding AIDS incidence at presentation and during follow-up among the various HIV-at-risk populations in Taiwan. A better understanding of AIDS incidence trends would help improve patient care and optimize public health strategies aimed at further decreasing HIV-related morbidity and mortality. Methods Data from Taiwan Centers for Disease Control-operated Notifiable Diseases Surveillance System and Taiwan National Health Insurance Research Database (1998–2012) was divided into five cohort periods (consecutive 3-year groups). Logistic regression was employed to identify factors associated with AIDS incidence at presentation. Time-dependent Cox regression was used to identify factors associated with AIDS incidence during the follow-up period. Results Of 22,665 patients [mean age: 32 years; male (93.03%)], 6210 (27.4%) had AIDS incidence over 2 (1.16) [median (interquartile range)] years of follow-up. AIDS developed in ≤3 months of HIV diagnosis in 73.6% AIDS patients. AIDS incidence trends at presentation and during follow-up differed according to HIV transmission routes over the five periods: AIDS at presentation increased in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.648 for bisexuals) but decreased to a nadir in period 3 and then increased slightly in period 5 (P < 0.001) in people who injected drugs (PWIDs). AIDS incidence during the follow-up period increased from period 1 to a peak in period 3 or 4, before declining slightly in period 5, in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.549 for bisexuals). However, it increased throughout the five periods in PWIDs (P < 0.001). Older age, sexual contact group versus PWIDs, high versus low income level, cohort periods, and HIV diagnosis regions helped predict AIDS at presentation and during follow-up. Conclusions Disparities in AIDS incidence trends in various HIV-at-risk populations reflect different sociodemographic variables of HIV exposure and the adopted HIV prevention strategies. This study suggests the urgent need for tailored strategies aimed at specific populations at presentation and during follow-up. |
| first_indexed | 2024-04-13T10:19:26Z |
| format | Article |
| id | doaj.art-3cb99c0cce0c4e09addc368c9c895cb6 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-13T10:19:26Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj.art-3cb99c0cce0c4e09addc368c9c895cb62022-12-22T02:50:32ZengBMCBMC Public Health1471-24582018-05-0118111410.1186/s12889-018-5500-zAIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in TaiwanChun-Yuan Lee0I-An Jen1Yu-Ching Lan2Yung-Feng Yen3Pei-Hung Chuang4Marcelo Chen5Yun Lee6Yi-Ming A. Chen7Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityDepartment and Institute of Public Health, National Yang-Ming UniversityDepartment of Health Risk Management, China Medical UniversityCenter for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical UniversityCenter for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General HospitalDepartment of Urology, Mackay Memorial HospitalCenter for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical UniversityCenter for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical UniversityAbstract Background Although Taiwan has implemented several important interventions for various HIV-at-risk populations to combat the HIV epidemic, little is known regarding AIDS incidence at presentation and during follow-up among the various HIV-at-risk populations in Taiwan. A better understanding of AIDS incidence trends would help improve patient care and optimize public health strategies aimed at further decreasing HIV-related morbidity and mortality. Methods Data from Taiwan Centers for Disease Control-operated Notifiable Diseases Surveillance System and Taiwan National Health Insurance Research Database (1998–2012) was divided into five cohort periods (consecutive 3-year groups). Logistic regression was employed to identify factors associated with AIDS incidence at presentation. Time-dependent Cox regression was used to identify factors associated with AIDS incidence during the follow-up period. Results Of 22,665 patients [mean age: 32 years; male (93.03%)], 6210 (27.4%) had AIDS incidence over 2 (1.16) [median (interquartile range)] years of follow-up. AIDS developed in ≤3 months of HIV diagnosis in 73.6% AIDS patients. AIDS incidence trends at presentation and during follow-up differed according to HIV transmission routes over the five periods: AIDS at presentation increased in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.648 for bisexuals) but decreased to a nadir in period 3 and then increased slightly in period 5 (P < 0.001) in people who injected drugs (PWIDs). AIDS incidence during the follow-up period increased from period 1 to a peak in period 3 or 4, before declining slightly in period 5, in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.549 for bisexuals). However, it increased throughout the five periods in PWIDs (P < 0.001). Older age, sexual contact group versus PWIDs, high versus low income level, cohort periods, and HIV diagnosis regions helped predict AIDS at presentation and during follow-up. Conclusions Disparities in AIDS incidence trends in various HIV-at-risk populations reflect different sociodemographic variables of HIV exposure and the adopted HIV prevention strategies. This study suggests the urgent need for tailored strategies aimed at specific populations at presentation and during follow-up.http://link.springer.com/article/10.1186/s12889-018-5500-zAcquired immunodeficiency syndromeAntiretroviral therapyHIVHomosexualHeterosexual |
| spellingShingle | Chun-Yuan Lee I-An Jen Yu-Ching Lan Yung-Feng Yen Pei-Hung Chuang Marcelo Chen Yun Lee Yi-Ming A. Chen AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan BMC Public Health Acquired immunodeficiency syndrome Antiretroviral therapy HIV Homosexual Heterosexual |
| title | AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan |
| title_full | AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan |
| title_fullStr | AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan |
| title_full_unstemmed | AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan |
| title_short | AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan |
| title_sort | aids incidence trends at presentation and during follow up among hiv at risk populations a 15 year nationwide cohort study in taiwan |
| topic | Acquired immunodeficiency syndrome Antiretroviral therapy HIV Homosexual Heterosexual |
| url | http://link.springer.com/article/10.1186/s12889-018-5500-z |
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