Late Presenters in New HIV Diagnoses from An Italian Cohort of HIV-Infected Patients: Prevalence and Clinical Outcome

Background To study the prevalence, predictors and outcome of late HIV diagnosis in the Icona cohort, according to the new European consensus definition of late diagnosis. Methods In this observational cohort study we investigated patients diagnosed with HIV over 3 months preceding enrolment who were defined as diagnosed late if they presented with AIDS or a CD4+ T-cell count ≤350/mm3 (European consensus definition). We estimated the prevalence of late diagnosis, identified factors associated with being diagnosed late and looked at the prognostic value of the European consensus definition of late presentation to predict subsequent clinical progression (new AIDS events or death). Results In total, 1,438/2,276 patients (63%) were defined as diagnosed late using the new European Consensus definition. Of these, 387 (16%) were AIDS-presenters. Predictors of being diagnosed late were older age, non-Italian origin, high HIV RNA and unemployment (versus retirement). A total of 293 patients showed clinical progression (3 events/100 person-years of follow-up, 95% CI: 2.7–3.4). Presenting late was strongly associated with a >5-fold increased risk of disease progression. Conclusions In our observational setting with free access to care, more than 60% of new HIV diagnoses occurred below the recommended threshold for initiating anti-retroviral treatment. Presenting late for care was associated with a high risk of clinical progression.

[1]  A. Mocroft,et al.  Late presentation of HIV infection: a consensus definition , 2011, HIV medicine.

[2]  B. Gazzard,et al.  Late diagnosis in the HAART era: proposed common definitions and associations with mortality , 2010, AIDS.

[3]  M. Johnson,et al.  Report of a European Working Group on Late Presentation with HIV Infection: Recommendations and Regional Variation , 2010, Antiviral therapy.

[4]  Michael J Silverberg,et al.  Effect of early versus deferred antiretroviral therapy for HIV on survival. , 2009, The New England journal of medicine.

[5]  Ross J. Harris,et al.  Prognosis of patients treated with cART from 36 months after initiation, according to current and previous CD4 cell count and plasma HIV-1 RNA measurements , 2009, AIDS.

[6]  G. Marks,et al.  Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis , 2009, AIDS.

[7]  A. Zolopa,et al.  Early Antiretroviral Therapy Reduces AIDS Progression/Death in Individuals with Acute Opportunistic Infections: A Multicenter Randomized Strategy Trial , 2009, PloS one.

[8]  Stephen R Cole,et al.  Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies , 2009, The Lancet.

[9]  Jeffrey N. Martin,et al.  Incomplete peripheral CD4+ cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  C. Mussini,et al.  Late Presenters in an HIV Surveillance System in Italy During the Period 1992-2006 , 2008, Journal of acquired immune deficiency syndromes.

[11]  Shari Messinger,et al.  HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  R. Weber,et al.  Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study , 2008, HIV medicine.

[13]  Y. Yazdanpanah,et al.  Characteristics trends, mortality and morbidity in persons newly diagnosed HIV positive during the last decade: the profile of new HIV diagnosed people. , 2008, European journal of public health.

[14]  J. Begovac,et al.  Late Presentation to Care for HIV Infection in Croatia and the Effect of Interventions During the Croatian Global Fund Project , 2008, AIDS and Behavior.

[15]  T. Hallett,et al.  Late Entry to HIV Care Limits the Impact of Anti-Retroviral Therapy in the Netherlands , 2008, PloS one.

[16]  G. Carcelain,et al.  CD4+ T-cell percentage is an independent predictor of clinical progression in AIDS-free antiretroviral-naive patients with CD4+ T-cell counts >200 cells/mm3 , 2008, Antiviral therapy.

[17]  A. Mocroft,et al.  The role of antiretroviral therapy in the incidence of pancreatitis in HIV-positive individuals in the EuroSIDA study , 2008, AIDS.

[18]  S. Curkendall,et al.  Incidence of anaemia among HIV‐infected patients treated with highly active antiretroviral therapy * , 2007, HIV medicine.

[19]  JD Lundgren,et al.  Normalisation of CD4 counts in patients with HIV-1 infection and maximum virological suppression who are taking combination antiretroviral therapy: an observational cohort study , 2007, The Lancet.

[20]  E. Lanoy,et al.  Frequency, determinants and consequences of delayed access to care for HIV infection in France , 2007, Antiviral therapy.

[21]  C. Sabin,et al.  The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004) , 2006, AIDS.

[22]  M. Bala,et al.  CD4/CD8 lymphocyte counts in healthy, HIV-positive individuals & AIDS patients. , 2006, The Indian journal of medical research.

[23]  G. Marks,et al.  Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA , 2006, AIDS.

[24]  J. Eron,et al.  Advanced immunosuppression at entry to HIV care in the southeastern United States and associated risk factors , 2006, AIDS.

[25]  C. Sabin,et al.  Newly diagnosed HIV infections: review in UK and Ireland , 2005, BMJ : British Medical Journal.

[26]  C. Sabin,et al.  No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993–2002) , 2005, AIDS.

[27]  M. Ogilvie,et al.  Heterosexual men and women with HIV test positive at a later stage of infection than homo- or bisexual men , 2004, International journal of STD & AIDS.

[28]  C. Sabin,et al.  Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy , 2004, AIDS.

[29]  G. Ippolito,et al.  Delayed Presentation and Late Testing for HIV: Demographic and Behavioral Risk Factors in a Multicenter Study in Italy , 2004, Journal of acquired immune deficiency syndromes.

[30]  J. Sánchez-Payá,et al.  [Predictors of progression and death in patients with advanced HIV infection in the era of highly active antiretroviral therapy]. , 2004, Enfermedades infecciosas y microbiologia clinica.

[31]  M. Gill,et al.  The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection , 2004, HIV medicine.

[32]  A. Telenti,et al.  CD4 T-lymphocyte recovery in individuals with advanced HIV-1 infection receiving potent antiretroviral therapy for 4 years: the Swiss HIV Cohort Study. , 2003, Archives of internal medicine.

[33]  V. Soriano,et al.  Rate, causes, and clinical implications of presenting with low CD4+ cell counts in the era of highly active antiretroviral therapy. , 2003, AIDS research and human retroviruses.

[34]  L. de la Fuente,et al.  Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence , 2002, AIDS.

[35]  M. Moroni,et al.  Insights into the reasons for discontinuation of the first highly active antiretroviral therapy (HAART) regimen in a cohort of antiretroviral naïve patients , 2000, AIDS.

[36]  E. Goetghebeur,et al.  Ten-year trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic , 2000, AIDS.

[37]  T. Quinn,et al.  Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. , 2000, The New England journal of medicine.

[38]  S. Chevret,et al.  Prognostic value of an elevated CD8 lymphocyte count in HIV infection. Results of a prospective study of 152 asymptomatic HIV‐positive individuals , 1992, AIDS.

[39]  N. Jewell,et al.  CD8+ T lymphocytes and progression to AIDS in HIV-infected men: some observations. , 1991, AIDS.

[40]  S. Pocock,et al.  Incidence , , 2018 .

[41]  R. Weber,et al.  Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008. , 2010, Archives of internal medicine.

[42]  J. Ordóñez‐Llanos,et al.  Metabolic syndrome among HIV-infected patients: prevalence, characteristics, and related factors. , 2005, Diabetes care.