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. 2021 Apr 21;16(4):e0249864.
doi: 10.1371/journal.pone.0249864. eCollection 2021.

Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018

Marta Rava  1 , Lourdes Domínguez-Domínguez  2 , Otilia Bisbal  2 , Luis Fernando López-Cortés  3 , Carmen Busca  4 , Antonio Antela  5 , Patricia González-Ruano  6 , Cristina Hernández  7 , Josè-Antonio Iribarren  8 , Rafael Rubio  2 , Santiago Moreno  9 , Inmaculada Jarrín  1 ; Cohort of the Spanish HIV/AIDS Research Network (CoRIS)
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Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018

Marta Rava et al. PLoS One. .

Abstract

Objectives: With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018.

Methods: CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality).

Results: 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08).

Conclusions: LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.

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Conflict of interest statement

We acknowledge that the project has been financed by Gilead Science, being Rafael Rubio and Santiago Moreno the PIs of the project. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Annual prevalence of LP and LPAD, 2004–2018.
Fig 2
Fig 2. Adjusted prevalence of late presentation by transmission category and time-period.
See this image and copyright information in PMC

References

    1. Wilson KDA, Dray-Spira R, Aubrière C, Hamelin C, Spire B, Lert F. Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group–results from the ANRS-VESPA2 Study, France. AIDS Care. 2014;26: S83–S93. 10.1080/09540121.2014.906554 - DOI - PubMed
    1. Raffetti E, Postorino MC, Castelli F, Casari S, Castelnuovo F, Maggiolo F, et al.. 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. BMC Public Health. 2016;16: 878. 10.1186/s12889-016-3477-z - DOI - PMC - PubMed
    1. Darcis G, Lambert I, Sauvage AS, Frippiat F, Meuris C, Uurlings F, et al.. Factors associated with late presentation for HIV care in a single Belgian reference center: 2006–2017. Sci Rep. 2018. 10.1038/s41598-018-26852-0 - DOI - PMC - PubMed
    1. Agaba PA, Meloni ST, Sule HM, Agbaji OO, Ekeh PN, Job GC, et al.. Patients who present late to HIV care and associated risk factors in Nigeria. HIV Med. 2014. 10.1111/hiv.12125 - DOI - PubMed
    1. Sobrino-Vegas P, Moreno S, Rubio R, Viciana P, Bernardino JI, Blanco JLJR, et al.. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013. J Infect. 2016;72: 587–596. 10.1016/j.jinf.2016.01.017 - DOI - PubMed

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