Late presenters among persons with a new HIV diagnosis in Italy, 2010–2011

Barbara Suligoi,Vincenza Regine,Maria Cristina Salfa,Laura Camoni,Mariangela Raimondo

doi:10.1186/1471-2458-13-281

Abstract

BackgroundIn Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010–2011.MethodsWe used individual data on new HIV diagnoses reported by the HIV surveillance system in 2010 and in 2011. Persons with CD4 ≤350 cells/μL or diagnosed with AIDS (regardless of the CD4 cell count) were defined as late presenters (LP); persons with CD4 ≤ 200 cells/μL or AIDS (regardless of the CD4 cell count) were defined as presenting with advanced HIV disease (AHD).ResultsOf the 7,300 new diagnoses reported in 2010–2011 by the included regions, 55.2% were LP; among these, 37.9% was diagnosed with AIDS. Persons presenting with AHD were 37.8%.The median age of LP was 40 years (IQR 33–48), significantly higher (p < 0.001) than that of non-LP (35 years); 73.9% were males; 30.7% were non-nationals. The median age of AHD was 42 years (IQR 35–50), 74.5% were males; 31.1% were non-nationals.The proportion of LP among IDUs was 59.8%, among heterosexuals (HET) 61.1% and among MSM 44.3%. The proportion of AHD among IDUs was 43.6%, among HET 43.2% and among MSM 27.4%.Factors significantly associated with being LP were: age older than 50 years (OR = 4.6 [95% CI 3.8-5.6]); having been diagnosed in Southern Italy (Southern vs Northern Italy OR = 1.5 [95% CI 1.3-1.7]) having been diagnosed in Central Italy (Central vs Northern Italy OR = 1.3 [95% CI 1.1-1.6]); being HET (HET vs MSM, OR = 1.7 [95% CI 1.5-2.0]), being non-national (Non-national vs Italian, OR 1.7 (95% CI 1.5-2.0); being IDU (IDU vs MSM, OR = 1.6 [95% CI 1.2-2.1]). The same factors were significantly associated with being AHD.ConclusionsOlder people, people diagnosed in Central and Southern Italy, non nationals, and persons who acquired the infection through injecting drug use or heterosexual contact showed a higher risk of being diagnosed late. A more active offer of HIV testing and targeted interventions focussed on these populations are needed to optimize early access to care and treatment.

Highlights

In Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late
Late presenters (LP) Of the 7,300 new HIV diagnoses reported in 2010–2011 by 19 regions, the number of CD4 cell count at HIV diagnosis was reported for 5,545 persons, of whom 3,059 (55.2%) were late presenters (LP), and 2,486 non-LP
Among men who have sex with men (MSM), 44.3% was LP (14.5% had an AIDS diagnosis, 11.9% was diagnosed with ≤200 cells/μL and 17.9% was diagnosed with 200–350 cells/μL); among injecting drug users (IDU) 59.8% was LP (20.1% had an AIDS diagnosis, 22.3% was diagnosed with ≤200 cells/μL and 17.4% was diagnosed with 200–350 cells/μL); among HET 61.1% was LP (21.9% had an AIDS diagnosis, 19.8% was diagnosed with ≤200 cells/μL and 19.4% was diagnosed with 200– 350 cells/μL) (Figure 1)

Summary

Introduction

In Western Europe, about 50% of newly diagnosed HIV-positive individuals are diagnosed at a late stage disease and enter in care late (i.e. with a CD4 count ≤350 μL/μL). The aim of the present study is to analyze the characteristics and the factors associated with being diagnosed late or at an advanced stage of disease among persons with a new HIV diagnosis in Italy, in the period 2010–2011. Of the approximately 2.3 million HIV-infected individuals living in the European region, it is estimated that one in three is unaware of his/her HIV serostatus (i.e. 700,000–900,000 individuals) [1], resulting in significant levels of late diagnosis and transmission across the region. In Western Europe, 45–50% of newly diagnosed HIVpositive individuals are diagnosed and enter care late (i.e. with a CD4 count ≤350 cells/μL) [2,3]. If a person is diagnosed early and HIV treatment is introduced early in the course of infection before severe impairment of the immune system has occurred, life-expectancy may approach that of the general population [13]

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