Abstract
BackgroundWe aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.MethodsAll antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.Results19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004–2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.ConclusionScreening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3477-z) contains supplementary material, which is available to authorized users.
Highlights
We aimed at evaluating frequency and factors associated with late presentation and advanced Human Immuno-Deficiency Virus (HIV) disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Standardized Management of Antiviral Therapy Cohort (Cohort)
From a public health perspective, people presenting late were spending longer time being unaware of their status, did not start any combination antiretroviral therapy, which is effective in reducing HIV RNA, so late presentation contributes to enhance rates of HIV transmission [11]
We further examined whether late presentation was associated with patient survival, and if differences in the mortality rates between late presenters and non late presenters improved overtime to have indications on possible gaps in HIV disease management that may be still present in these patients
Summary
We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. Some studies reported that community HIV RNA concentrations were correlated with incedence of new HIV diagnoses in specific contexts (e.g., among IDUs or men who have sex with men, MSM) [12, 13]. For these reasons, the World Health Organization (WHO), promotes initiatives to increase HIV testing and retention into care, aimed at reducing rates of late diagnosis and HIV transmission [14], but in reality such campaigns are poorly implemented in some contexts
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