Abstract
This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.
Highlights
Delayed diagnosis and treatment of HIV infection is a huge problem worldwide, with important individual and public health consequences
This paper presents data on late presentation (LP) among men who have sex with men (MSM) newly diagnosed with HIV in the EPI-VIH Network in Spain
Among MSM diagnosed in this network, LP is less common than in those diagnosed elsewhere, but presenting late is not evenly distributed, and the effect of region of birth on LP varies depending on the levels of two other variables
Summary
Delayed diagnosis and treatment of HIV infection is a huge problem worldwide, with important individual and public health consequences. A consensus definition was proposed in Europe in 2010 and 2011 defining advanced disease (AD) as presenting a CD4 count below 200 cells/μL or AIDS at diagnosis, and late presentation (LP) as having less than 350/μL or AIDS [8,9]. The proportion of LP was higher among heterosexuals (59.1%) and people who inject drugs (PWID) (55.9%) than among men who have sex with men (MSM), (38.4%). In Spain, using the same definition, 48% of new HIV diagnoses reported to the national surveillance system that same year presented late; variations across exposure categories are similar, with MSM having the lowest proportion of LP in comparison to PWID and heterosexuals (39%, 59% and 65% respectively) [11]
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