Treatment
Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009
Garcia de Olalla P, Mazardo C, Sambeat MA, Ocana I, Knobel H, Humet V, Domingo P, Ribera E, Guelar A, Marco A, Belza MJ, Miro JM, Cayla1 JA, Hivsg TH. AIDS Res Ther. 2011 Jul 6;8(1):22.
Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09. Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression was used to identify predictors of late presentation. Of the 2,938 newly diagnosed HIV-infected individuals, 2507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1139 (55.6%) of the 2507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p=0.001) but remained constant thereafter (p=0.9). Independent risk factors for late presentation were older age at diagnosis (p<0.0001), use of injected drugs by men (p<0.0001), being a heterosexual man (p<0.0001), and being born in South America (p<0.0001) or sub-Saharan Africa (p= 0.002). Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in Barcelona. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.
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Editor’s note: Since 1987, Barcelona has had an active AIDS surveillance system collecting information from physicians about new AIDS diagnoses, hospitals about AIDS discharge diagnoses, tuberculosis registers about patients with AIDS, and vital statistics bureaux about AIDS deaths. In 2001, an HIV surveillance system was added to collect information about new HIV diagnoses, using a unique patient identifier to minimise double counting. The 9-year trends of newly diagnosed HIV infections show increasing proportions of men who have sex with men (40% in 2001-3 to 62% in 2008-9) and increasing proportions of migrants (23% to 46%) having arrived in Spain from less than a year to more than 10 years previously. Men who have sex with men were less likely to present late than men who inject drugs (48% versus 66%), with the latter having the longest delays between HIV diagnosis and the first CD4 count that could trigger initiation of antiretroviral therapy (162 days versus 54 days for others), possibly because the drug rehabilitation centres and prisons where they learned their HIV status did not have accessible CD4 count testing. Overall, for each increase in age of 5 years, the risk of presenting late increased 38%⎯older people and their physicians are clearly not thinking about HIV. Surveillance systems such as these in Barcelona can inform the tailoring of programmes aimed at earlier entry into HIV care and treatment to decrease HIV progression, stimulate immune recovery, and reduce onward transmission.
