Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

Mehdi Sharafi; Alireza Mirahmadizadeh; Jafar Hassanzadeh; Mozhgan Seif; Alireza Heiran

doi:10.3389/fpubh.2023.1029608

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

Front Public Health. 2023 Apr 17:11:1029608. doi: 10.3389/fpubh.2023.1029608. eCollection 2023.

Authors

Mehdi Sharafi¹, Alireza Mirahmadizadeh², Jafar Hassanzadeh³, Mozhgan Seif⁴, Alireza Heiran²

Affiliations

¹ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
² Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Department of Epidemiology, School of Health, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Non-communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Objective: Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran.

Methods: This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group.

Results: The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients.

Conclusion: A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Keywords: AIDS; CD4 depletion model; HIV; Iran; delayed diagnosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome* / drug therapy
Cross-Sectional Studies
Delayed Diagnosis
Female
HIV Infections* / diagnosis
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Homosexuality, Male
Humans
Iran / epidemiology
Male
Sexual and Gender Minorities*

Grants and funding

This study was funded by Shiraz University of Medical Sciences (Grant No. 23039).