Journal Article

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

Postorino, Maria Concetta, Zacchi, Fabio, D’Avino, Alessandro, Torti, Carlo, Di Filippo, Elisa, Di Pietro, Massimo, Castelnuovo, Filippo, Maggiolo, Franco, Raffetti, Elena, Casari, Salvatore, Castelli, Francesco, Sighinolfi, Laura, Ladisa, Nicoletta, Gori, Andrea

2016

Overview

Background 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. Methods All 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. Results 19,391 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. Conclusion Screening 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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / Adult / Advanced HIV disease / Age Factors / AIDS / Antiretroviral agents / Antiretroviral drugs / Biostatistics / CD4 antigen / CD4 Lymphocyte Count / CD4-Positive T-Lymphocytes / Death / Delayed Diagnosis - statistics & numerical data / Diagnosis / Environmental Health / Epidemiology / Female / Heterosexuality - statistics & numerical data / HIV / HIV infection / HIV Infections - diagnosis / HIV Infections - epidemiology / Human immunodeficiency virus / Humans / Infectious Disease epidemiology / Italy / Late diagnosis / Late presentation / Lymphocytes / Lymphocytes T / Male / Medical diagnosis / Medicine / Medicine & Public Health / Middle Aged / Mortality / Patient outcomes / Proportional Hazards Models / Public Health / Regression analysis / Research Article / Risk analysis / Risk Factors / Survival / Survival Rate / Vaccine / Young Adult