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. 2020 Oct 7;20(1):728.
doi: 10.1186/s12879-020-05261-7.

Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010-2016

Late Presentation Working Groups in EuroSIDA and COHERE

Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010-2016

Late Presentation Working Groups in EuroSIDA and COHERE. BMC Infect Dis. .

Abstract

Background: Late presentation (LP), defined as a CD4 count < 350/mm3 or an AIDS-event at HIV-diagnosis, remains a significant problem across Europe. Linking cohort and surveillance data, we assessed the country-specific burden of LP during 2010-2016 and the occurrence of new AIDS events or deaths within 12 months of HIV-diagnosis believed to be attributable to LP.

Methods: Country-specific percentages of LP and AIDS-events/death rates (assessed with Poisson regression) observed in The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and EuroSIDA cohorts, were applied to new HIV-diagnoses reported to the European Centre for Disease Prevention and Control. The estimated number of LP in the whole population was then calculated, as was the number of excess AIDS-events/deaths in the first 12 months following HIV-diagnosis assumed to be attributable to LP (difference in estimated events between LP and non-LP).

Results: Thirty-nine thousand two hundred four persons were included from the COHERE and EuroSIDA cohorts, of whom 18,967 (48.4%; 95% Confidence Interval [CI] 47.9-48.9) were classified as LP, ranging from 36.9% in Estonia (95%CI 25.2-48.7) and Ukraine (95%CI 30.0-43.8) to 64.2% in Poland (95%CI 57.2-71.3). We estimated a total of > 320,000 LP and 12,050 new AIDS-events/deaths attributable to LP during 2010-2016, with the highest estimated numbers of LP and excess AIDS-events/deaths in Eastern Europe. Country-level estimates of excess events ranged from 17 AIDS-events/deaths (95%CI 0-533) in Denmark to 10,357 (95%CI 7768-147,448) in Russia.

Conclusions: Across countries in Europe, the burden of LP was high, with the highest estimated number of LP and excess AIDS-events/deaths being in Eastern Europe. Effective strategies are needed to reduce LP and the attributable morbidity and mortality that could be potentially avoided.

Keywords: AIDS; Avoidable events; Eastern Europe; HIV; HIV testing; Late presentation.

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Conflict of interest statement

All authors declare no conflicts of interest related to this article.

Figures

Fig. 1
Fig. 1
Proportion of late presenters in COHERE and EuroSIDA 2010–2016, using surveillance (TESSy) data as a reference population. Estimates were assigned weights to reproduce key demographic characteristics (age, sex, HIV transmission category) of all diagnosed HIV-positive in each country or region during the study period. * Not possible to calculate weighted estimate because of lack of data from either COHERE/EuroSIDA or TESSy. CI = confidence interval
Fig. 2
Fig. 2
Estimated excess events per 1,000,000 inhabitants in each country. The figure shows the estimated excess AIDS-events/deaths attributable to late presentation, when differences in population size are accounted for. The sensitivity analysis gives the estimated excess events, when people with a new AIDS event within 6 months of HIV-diagnosis are excluded. The population estimates in each country are based on data from Eurostat (number of persons having their usual residence in a country on 1st January 2016) [24]. *For Russia, the population estimate from 2014 (most recent available) was used
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