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. 2017 Feb 16;14(1):8.
doi: 10.1186/s12981-016-0129-4.

Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study

Giovanni Guaraldi  1 , Stefano Zona  2 , Marianna Menozzi  2 , Thomas D Brothers  3 , Federica Carli  2 , Chiara Stentarelli  2 , Giovanni Dolci  2 , Antonella Santoro  2 , Ana Rita Domingues Da Silva  4 , Elisa Rossi  5 , Julian Falutz  6 , Cristina Mussini  2
Affiliations

Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study

Giovanni Guaraldi et al. AIDS Res Ther. .

Abstract

Background: Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious comorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP and HIV + EP, respectively), and compare them to matched HIV-negative control participants from a community-based cohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in HIV patients.

Methods: We performed a matched cohort study including HIV + LP and HIV + EP among people attending the Modena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative participants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of ≥2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity.

Results: We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The mean age was 46 ± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the HIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated with increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after adjusting for age, multimorbidity, and antiretroviral costs.

Conclusions: LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and multimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently needed.

Keywords: Comorbidities; Costs; HIV; Late presentation.

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Figures

Fig. 1
Fig. 1
NICM and MM prevalence distribution across study groups
Fig. 2
Fig. 2
Age-related risk probability for CVD, T2DM and MM
Fig. 3
Fig. 3
Multivariable logistic regression model to detect independent predictors of MM in the cohort
Fig. 4
Fig. 4
Total and cART costs of medical care in HIV negative, HIV + EP and HIV + LP across age strata (mean)
See this image and copyright information in PMC

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