Abstract
BackgroundEarly diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.MethodsDemographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.ResultsOf the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).ConclusionLate presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.
Highlights
In the European Union it is estimated that 15-38% of cases of human immunodeficiency virus (HIV) infection are diagnosed late [1] and 30% of infected individuals are not aware of their serological status, with proportions that vary between 12% and 20% in Sweden to more than 50% in Poland [2]
According to the new European definition[19], late presenters (LP) was defined for persons presenting for care with a CD4 count below 350 cells/μl or presenting with an AIDS-defining event at the time of HIV diagnosis or within 3 months of the HIV-positive test, regardless of the CD4 cell count
We observed that the proportion of injecting drug users (IDU) among males decreased during the study period (p < 0.0001), whereas the proportion of sex between men (MSM) increased from 40.2% in 2001-03 to 61.9% in 2008-09 (p < 0.0001)
Summary
In the European Union it is estimated that 15-38% of cases of HIV infection are diagnosed late [1] and 30% of infected individuals are not aware of their serological status, with proportions that vary between 12% and 20% in Sweden to more than 50% in Poland [2]. In Spain 56.3% of new diagnoses of HIV infection between 2003 and 2007 required treatment (CD4 < 350 cells/μl) at the Reducing the time elapsed between infection and the initiation of antiretroviral therapy (ART) is important to decrease progression of the infection and to facilitate immunological recovery. Delays in HIV care have serious public health implications because opportunities to prevent further transmission through effective ART are lost [7,8], and because de Olalla et al AIDS Research and Therapy 2011, 8:22 http://www.aidsrestherapy.com/content/8/1/22 initiating treatment for HIV infection at an advanced stage leads to poorer treatment outcomes than with early treatment [9,10]. Some studies have shown that after HIV infection diagnosis, most infected individuals remain sexually active, most use safer practices, thereby limiting infection spread [11,12,13]. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09
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