Abstract
Background and aimsLate HIV diagnosis is associated with onward HIV transmission, higher morbidity, mortality and healthcare costs. In Italy, more than half of people living with HIV were diagnosed late during the last decade, with a CD4 count < 350 cells/mm3 at diagnosis. We aimed to determine the number and characteristics of people living with undiagnosed HIV infection and low CD4 counts in Italy.MethodsData on newly reported HIV diagnoses from 2012 –2014 were obtained from the national HIV surveillance system. We used the European Centre for Disease Prevention and Control HIV modelling tool to calculate the undiagnosed prevalence and yearly diagnosed fraction (YDF) in people with low CD4 count.ResultsThe estimated annual number undiagnosed HIV infections with low CD4 count was on average 6,028 (95% confidence interval (CI): 4,954–8,043) from 2012–2014. In 2014, most of the undiagnosed people with low CD4 count were men (82.8%), a third acquired HIV through sex between men (MSM) (35.0%), and heterosexual transmission (33.4%), respectively. The prevalence of undiagnosed HIV infection was 11.3 (95% CI: 9.3–14.9) per 100,000 residents ranging from 0.7 to 20.8 between Italian regions. Nationally the prevalence rate was 280.4 (95% CI: 173.3–450.2) per 100,000 MSM, 8.3 (95% CI: 4.9–13.6) per 100,000 heterosexual men, and 3.0 (95% CI: 1.4–5.6) per 100,000 women. The YDF was highest among heterosexual women (27.1%; 95% CI: 16.9–45.2%).ConclusionsThese findings highlight the importance of improving efforts to identify undiagnosed HIV infections primarily among men, both MSM and heterosexual men.
Highlights
Late diagnosis of HIV remains a major public health concern worldwide [1,2,3]
Clinical stage at HIV diagnosis was reported for 70% of people, 39% of them were diagnosed at clinical advanced stage
The estimated number of people living with undiagnosed HIV infection and with CD4 count < 350 cells/mm3 in Italy was 6,028 in 2012, 6,156 in 2013, and 5,899 in 2014
Summary
Of people newly diagnosed with HIV in European countries were late presenters, with CD4 counts below 350 cells/mm at diagnosis, including 28% with advanced HIV infection (CD4 < 200 cells/mm3) [1]. Individuals who are in an advanced stage of immunosuppression due to HIV are at high risk of clinical events and death [6,7] At population level, those diagnosed late are a potential source of HIV transmission for a considerable period [8]. In Italy, more than half of people living with HIV were diagnosed late during the last decade, with a CD4 count < 350 cells/mm at diagnosis. In 2014, most of the undiagnosed people with low CD4 count were men (82.8%), a third acquired HIV through sex between men (MSM) (35.0%), and heterosexual transmission (33.4%), respectively. Conclusions: These findings highlight the importance of improving efforts to identify undiagnosed HIV infections primarily among men, both MSM and heterosexual men
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