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

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.

Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000–2010

“…T cell count. As reported by many studies conducted in Italy as well as in other European countries, a relevant proportion of infected patients actually get to diagnosis when immunological and clinical conditions are severely compromised [17,[22][23][24][25][26].…”

Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

“…The decreases in late presentation are likely associated with changes to provider initiated HIV testing policies and the massive scale-up of antenatal screening for HIV [20],[21]. Factors associated with late presentation in this and previous studies included non-MSMs HIV-exposure group [1],[5],[14],[16],[17],[22], older age [1],[14],[16]–[19],[23], and non-European origin [14],[17],[19],[22],[24]. Reasons for the increase in late presentation among IDUs in Eastern Europe and heterosexual females and male IDUs from Southern Europe may include suboptimal health care offered to these populations, differences in characteristics that we were unable to adjust for, such as socioeconomic status, the pattern of the underlying epidemic, and appearance of symptoms that may ultimately promote presentation for care [25],[26].…”

Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD

“…28,29 Late-diagnosed patients would be expected to be older than patients diagnosed for other reasons because HIV-related symptoms usually develop after a prolonged period of infection at which point immune system has been weakened. 30,31 In addition, a previous study reported that older patients was more likely to be diagnosed during hospitalization, and they suggested that these populations may have lower perceived risk for HIV infection.…”