Leading HIV Experts Convene to Tackle the Challenge of Late Presentation in Europe

London (ots/PRNewswire) -

- Between 15 to 38 percent of HIV-infected persons in Europe do
not present for screening and treatment until late in infection.(1)
Late presentation has been show to result in increased morbidity(1)
and decreasing quality of life.(2,3)

Almost three decades after the discovery of HIV/AIDS, and despite
big medical advances, there are still a significant number of
HIV-infected persons who present late in the disease course and with
severe immunosuppression. This often results in less than optimal
outcomes, with increased mortality, morbidity and decreased quality
of life.(2,3) In Europe, between 15 to 38 percent of those infected
with HIV do not present for testing until late in infection, when
their CD4 cell counts are low, viral load high, and the immune system
has been significantly compromised.(1) To address this issue, leading
HIV experts from across Europe convened today at a meeting titled
"Late Presentation for HIV Treatment in Europe" sponsored by
Bristol-Myers Squibb Company (NYSE: BMY). Topics that were covered
include research on late presentation, its public health implications
in Western Europe, early HIV testing, and the management of late
presenters.

"Late presentation can have negative consequences for both the
individual and the larger population. Late HIV presenters typically
have a poor disease outcome, are less likely to respond to treatment
once initiated, and are more likely to transmit the disease to
others," said conference co-chair Margaret Johnson, MD, clinical
director and consultant physician of general medicine, HIV/AIDS and
thoracic medicine at the Royal Free Hospital in London. "This meeting
is extremely timely given the gravity of the issue in Western Europe.
As clinicians and concerned citizens, we must act now to encourage
earlier HIV testing and treatment, and help reduce the stigma of HIV
diagnosis in all communities."

Although the rates of late presentation vary based on countries
and definitions used,(1) some studies indicate that:

- 28 percent of patients in Spain had a first positive HIV test in the
month of or immediately before AIDS diagnosis(4)
- 33 percent of patients in the United Kingdom,(5) 38 percent in
France,(6) and 39 percent in Italy(7) received their diagnosis when
their CD4 cell count was less than 200/mm3, and/or disease progressed
to clinical AIDS during the year of diagnosis
- In Sweden, 45 percent of patients were diagnosed with HIV less than
three months before AIDS diagnosis(8)
- In Germany, 30 percent of patients were diagnosed with a CD4 cell count
less than 200/mm3(1)

These patients are more likely to acquire opportunistic
infections, and to present with multiple illnesses within a short
time period.(3) Delayed presenters may also have a poorer treatment
response when they do start highly active antiretroviral therapy
(HAART).(3) Antiretroviral drug resistance is also an issue in this
population.(3)

It has been shown that earlier HIV diagnosis results in more
favourable outcomes in short-term mortality (56 percent overall
improvement) and heterosexually-acquired AIDS mortality (32 percent
improvement).(1) Earlier HIV diagnosis may also help control the
spread of the epidemic.(9) Recent changes to HIV treatment guidelines
confirm the need for patients and physicians to consider treatment as
early as CD4 cell count of 350-500 cells/mm3.(9,10) The 2008
International AIDS Society (IAS) treatment supports new data and
considerations for initiating therapy before CD4 cell count falls
below 350 cells/mm3,(10) an update to the 2006 version of the IAS
guidelines, which recommended antiretroviral therapy for asymptomatic
patients whose CD4 cell count is equal to or less than 200
cells/mm3.(11) Additionally, the 2008 guidelines state that, in
patients with a count of 350 CD4 cells/mm3 or more, the decision to
begin therapy should be individualized based on the presence of
comorbidities, risk factors for progression to AIDS and non-AIDS
diseases, and patient readiness for treatment.(10)

"Early treatment allows for greater immunological recovery, a
reduction of AIDS progression, a reduced risk of related illnesses,
and lower mortality," said conference co-chair Jürgen Rockstroh, MD,
director of the Bonn University Clinic and professor in the
department of medicine at University of Bonn, Germany. "Thanks to
advances in medical research, there are a number of HIV treatment
options available for low CD4 cell count patients, including the late
presentation population. Antiretroviral therapy now makes it possible
for many HIV-infected persons to live long, and fairly normal,
lives."

*About Late Presentation

Although there is no standard definition of late presentation, in
clinical literature late presenters have been most frequently defined
as patients who present with low CD4 cell count (less than 200/mm3)
and those who receive HIV diagnosis within three months of AIDS
diagnosis.(1) Some studies have also defined late presenters as those
who present with CD4 cell count of less than 350.(1) In addition,
delayed presenters have been defined as patients with more than six
months between their first HIV positive test and presentation for HIV
care,(12) or simply those who present for HIV care after it may have
been beneficial to begin treatment.(1)

Research shows that as many as 77 percent of all AIDS-related
deaths could be considered late presenters,(1) and that baseline CD4
cell count is strongly associated with the probability of progression
to death.(13) Among late presenters, there is significant short-term
mortality, at a rate much higher than those who receive an earlier
HIV diagnosis.(3)

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References

(1) Adler, A., et al. Late Diagnosis of HIV in Europe:
Definitional and Public Health Challenges. AIDS Care; 2008; 1-10.

(2) Sanders, GD., et al. Cost-Effectiveness of Screening for HIV
in the Era of Highly Active Antiretroviral Therapy. N Engl J Med;
2005; 352; 6.

(3) Girardi, E., et al. Late Diagnosis of HIV Infection:
Epidemiological Features, Consequences and Strategies to Encourage
Earlier Testing. J Acquir Immune Defic Syndr. 2007; 46: S3-S8.

(4) Castilla, J., et al. Late Diagnosis of HIV Infection in the
Era of Highly Active Antiretroviral Therapy: Consequences on AIDS
Incidence. AIDS. 2002; 16: 1945-51.

(5) Sullivan, A., et al. Newly Diagnosed HIV Infections: Review
in UK and Ireland. BMJ. 2005; 330: 1301-2.

(6) Delpierre, C., et al. High-Risk Groups for Late Diagnosis of
HIV Infection: A Need for Rethinking Testing Policy in the General
Population. AIDS Patient Care and STDs. 2006; 20: 838-47.

(7) Borghi, V., et al. Late Presenters in an HIV Surveillance
System in Italy During the Period 1992-2006. J Acquir Immune Defic
Syndr. 2008; Nov 1; 49(3): 282-6.

(8) Brannstrom et al. Patients Unaware of their HIV Infection
until AIDS Diagnosis in Sweden 1996-2002 - A Remaining Problem in the
Highly Active Antiretroviral Therapy Era. INT J STD AIDS. 2005; 16:
702-6.

(9) BHIVA Treatment Guidelines Writing Group. British HIV
Association Guidelines for the Treatment of HIV-1-infected Adults
with Antiretroviral Therapy 2008. HIV Medicine. 2008; 9, 563-608.

(10) Hammer, S., et al. Antiretroviral Treatment of Adult HIV
Infection - 2008 Recommendations of the International AIDS
Society-USA Panel. JAMA. 2008; 300(5): 555-570.

(11) Hammer, SM., et al. Treatment of Adult HIV Infection: 2006
Recommendations of the International AIDS Society - USA. JAMA. 2006;
296(7) P827-843.

(12) Girardi, E., et al. Delayed Presentation and Late testing
for HIV: Demographic and Behavioural Risk Factors in a Multicenter
Study in Italy. JAIDS. 2004; 36: 951-59.

(13) Egger, M., et al. Prognosis of HIV-1-infected Patients
Starting Highly Active Antiretroviral Therapy: A Collaborative
Analysis of Prospective Studies. Lancet. 2002 Jul 13; 360(9327):
119-29.

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Contact:
Annie Simond, Bristol-Myers Squibb, +33-01-58-83-65-66