Determinants of HIV-1 Late Presentation in Patients Followed in Europe

Abstract

To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm³ or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0-41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.

Keywords: Europe; HIV-1 infection; late presentation.

Figure 1

Bayesian Network analysis of association between variables investigated in the study. The BayesNet classifier and the HillClimber algorithm were used as implemented in the WEKA software. LP—Late Presenters; VL—Viral Load; MT—Mode of Transmission; RI—Recentness of infection; RO—Region of Origin; MS—Migrant Status.

Figure 2

Evolution of Late Presenters rate per Year. Vertical black lines represent confidence intervals.

Figure 3

Schematic representation of determinants of late presentation based on logistic regression and Bayesian networks analysis. The light grey box indicates the direct determinants, and the dark grey box indicates the indirect determinants of late presentation. Individuals older than 56yo and originated from Africa had higher probability of being late presenters, Men who have sex with men were less likely to be late presenters. In the clinical determinants there were only direct associated determinants. Individuals with a viral load higher than 4.1 copies/mL had higher probability of being late presenters and individuals with a lower rate of sequence ambiguity had lower probability of being late presenters. MSM-Men who have sex with Men.