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. 2024 Feb 29:12:1336845.
doi: 10.3389/fpubh.2024.1336845. eCollection 2024.

Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind?

Ricardo Abrantes #  1 , Victor Pimentel #  1 , Mafalda N S Miranda  1 , Ana Rita Silva  2 , António Diniz  3 , Bianca Ascenção  4 , Carmela Piñeiro  5 , Carmo Koch  6 , Catarina Rodrigues  7 , Cátia Caldas  5 , Célia Morais  8 , Domitília Faria  9 , Elisabete Gomes da Silva  10 , Eugénio Teófilo  11 , Fátima Monteiro  6 , Fausto Roxo  12 , Fernando Maltez  13 , Fernando Rodrigues  8 , Guilhermina Gaião  14 , Helena Ramos  15 , Inês Costa  16 , Isabel Germano  7 , Joana Simões  7 , Joaquim Oliveira  17 , José Ferreira  18 , José Poças  4 , José Saraiva da Cunha  17 , Jorge Soares  5 , Sandra Fernandes  16 , Kamal Mansinho  19 , Liliana Pedro  9 , Maria João Aleixo  20 , Maria João Gonçalves  21 , Maria José Manata  13 , Margarida Mouro  22 , Margarida Serrado  3 , Micaela Caixeiro  23 , Nuno Marques  20 , Olga Costa  24 , Patrícia Pacheco  23 , Paula Proença  25 , Paulo Rodrigues  2 , Raquel Pinho  9 , Raquel Tavares  2 , Ricardo Correia de Abreu  26 , Rita Côrte-Real  24 , Rosário Serrão  5 , Rui Sarmento E Castro  21 , Sofia Nunes  22 , Telo Faria  10 , Teresa Baptista  19 , Daniel Simões  27 , Luis Mendão  27 , M Rosário O Martins  1 , Perpétua Gomes  16   28 , Marta Pingarilho #  1 , Ana B Abecasis #  1 ; BESTHOPE Study Group
Affiliations

Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind?

Ricardo Abrantes et al. Front Public Health. .

Abstract

Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019.

Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP).

Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP.

Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.

Keywords: HIV-1; Portugal; drug resistance; late presentation; men who have sex with men; vulnerable populations.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Adjusted logistic regression analysis of sociodemographic, behavior, testing, prophylaxis and STIs factors associated with HIV late presentation status (LP). STI, Sexual transmitted infections.
Figure 2
Figure 2
Adjusted logistic regression analysis of clinical and genomic factors associated with HIV late presentation status (LP). STI, Sexual transmitted infections.
See this image and copyright information in PMC

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