Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009

AIDS Research and Therapy

Patricia Garcia de Olalla⁴  Christian Manzardo²  Maria A Sambeat⁵  Inma Ocaña¹  Hernando Knobel³  Victoria Humet⁷  Pere Domingo⁵  Esteve Ribera¹  Ana Guelar³  Andres Marco⁷  Maria J Belza⁶  Josep M Miró²  Joan A Caylà⁴ 

[1] Infectious Diseases, Hospital Vall de Hebron. Universitat Autònoma de Barcelona, Barcelona, Spain

[2] Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain

[3] Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain

[4] Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP

[5] Infeccious Diseases Unit, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain

[6] Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain

[7] Direcció General de Serveis Penitenciaris i de Rehabilitació. Departament de Justícia. Barcelona, Spain

关键词: Spain;    Barcelona;    Predictors;    Epidemiology;    Late presentation;    HIV infection;   

Others  :  789731
DOI  :  10.1186/1742-6405-8-22

 received in 2011-04-18, accepted in 2011-07-06,  发布年份 2011

【 摘 要 】

Background

Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.

Methods

Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.

Results

Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).

Conclusion

Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.

【 授权许可】

   
2011 de Olalla et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Adler A, Mounier-Jack S, Coker RJ: Late diagnosis of HIV in Europe: definitional and public health challenges. AIDS Care 2009, 21:284-293.
• [2]Hamers FF, Phillips AN: Diagnosed and undiagnosed HIV-infected populations in Europe. HIV Med 2008, 9(Suppl 2):6-12.
• [3]Oliva J, Galindo S, Vives N, Arrillaga A, Izquierdo A, Nicolau A, Castilla J, Lezaun ME, Alvarez M, Rivas A, Díez M: Delayed diagnosis of HIV infection in Spain. Enferm Infecc Microbiol Clin 2010, 28:583-589.
• [4]World Health Organization: Report of the Meeting on Criteria for HIV Screening Programes [WHO/SPA/GLO/87.2]. [http://whqlibdoc.who.int/hq/1987/WHO_SPA_GLO_87.2_spa.pdf] webciteGeneva:WHO; 1987. Accessed January 2011
• [5]Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE: Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006, 55(RR-14):1-17.
• [6]Secretaría del Plan Nacional sobre el Sida. Infección por VIH y SIDA: Plan Multisectorial 2008-2012. Ministerio de Sanidad y Consumo. [http:/ / www.msps.es/ ciudadanos/ enfLesiones/ enfTransmisibles/ sida/ docs/ PMS200812.pdf] webciteMadrid 2008. Accessed January 2011
• [7]Attia S, Egger M, Muller M, Zwahlen M, Low N: Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009, 23:1397-1404.
• [8]Marks G, Crepaz N, Senterfitt JW, Janssen RS: Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005, 39:446-453.
• [9]Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998, 338:853-860.
• [10]Sobrino-Vegas P, García-San Miguel L, Caro-Murillo AM, Miró JM, Viciana P, Tural C, Saumoy M, Santos I, Sola J, del Amo J, Moreno S, CoRIS: Delayed diagnosis of HIV infection in a multicenter cohort: prevalence, risk factors, response to HAART and impact on mortality. Curr HIV Res 2009, 7:224-230.
• [11]Weinhardt LS, Carey MP, Johnson BT: Effect of HIV counseling and testing on sexual behavior: a meta-analytic review of published research, 1985-1997. Am J Pub Health 1999, 89:1397-1410.
• [12]Johnson WD, Diaz RM, Flanders WD, Goodman M, Hill AN, Holtgrave D, Malow R, McClellan WM: Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev 2008, 3:CD001230.
• [13]Marks G, Crepaz N, Janssen RS: Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006, 20:1447-1450.
• [14]Fleishman JA, Yehia BR, Moore RD, Gebo KA, HIV Research Network: The economic burden of late entry into medical care for patients with HIV infection. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022268/pdf/nihms-262526.pdf] webciteMed Care 2010, 48:1071-1079. Accessed February 2011
• [15]Velasco M, Losa JE, Espinosa A, Sanz J, Gaspar G, Cervero M, Torres R, Condes E, Barros C, Castilla V: Economic evaluation of assistance to HIV patients in a Spanish hospital. Eur J Intern Med 2007, 18:400-404.
• [16]Krentz HB, Gill J: Despite CD4 cell count rebound the higher initial costs of medical care for HIV-infected patients persist 5 years after presentation with CD4 cell counts less than 350 μl. AIDS 2010, 24:2750-2753.
• [17]Romaguera A, Binefa G, Casabona J, García de Olalla P, Caylà J, Camps N, Company M, Minguell S, Godoy P, Sala MR, Humet V, Alvarez J, Barrabeig I, Grupo de médicos coordinadores de VIH/sida: Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results. Gac Sanit 2005, 19:356-362.
• [18]Commission decision of 28/IV/2008 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council [http:/ / www.ecdc.europa.eu/ en/ healthtopics/ spotlight/ Documents/ 080428_amending_desicion_Decision_2 002-253-EC_on_case%20definitions.pd f] webciteAcquired Immunodeficiency Virus (AIDS) and Human Immunodeficiency Virus (HIV) InfectionAccessed February 2011
• [19]Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, Girardi E, Johnson M, Kirk O, Lundgren J, Mocroft A, D'Arminio Monforte A, Phillips A, Raben D, Rockstroh JK, Sabin C, Sönnerborg A, De Wolf F, European Late Presenter Consensus Working Group: Late presentation of HIV infection: a consensus definition. HIV Med 2011, 12:61-64.
• [20]23750 LEY ORGÁNICA 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal. BOE núm. 298 [http://www.boe.es/boe/dias/1999/12/14/pdfs/A43088-43099.pdf] webcite 1999, 43088-43097. Accessed February 2011
• [21]Caro-Murillo AM, Castilla J, Pérez-Hoyos S, Miró JM, Podzamczer D, Rubio R, Riera M, Viciana P, López Aldeguer J, Iribarren JA, de los Santos-Gil I, Gómez-Sirvent JL, Berenguer J, Gutiérrez F, Saumoy M, Segura F, Soriano V, Peña A, Pulido F, Oteo JA, Leal M, Casabona J, del Amo J, Moreno S, Grupo de trabajo de la Cohorte de la Red de Investigación en Sida (CoRIS): Spanish cohort of naïve HIV-infected patients (CoRIS): rationale, organization and initial results. Enferm Infecc Microbiol Clin 2007, 25:23-31.
• [22]Althoff KN, Gange SJ, Klein MB, Brooks JT, Hogg RS, Bosch RJ, Horberg MA, Saag MS, Kitahata MM, Justice AC, Gebo KA, Eron JJ, Rourke SB, Gill MJ, Rodriguez B, Sterling TR, Calzavara LM, Deeks SG, Martin JN, Rachlis AR, Napravnik S, Jacobson LP, Kirk GD, Collier AC, Benson CA, Silverberg MJ, Kushel M, Goedert JJ, McKaig RG, Van Rompaey SE, Zhang J, Moore RD: Late presentation for human immunodeficiency virus care in the United States and Canada. Clin Infect Dis 2010, 50:1512-1520.
• [23]When To Start Consortium, Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR: Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet 2009, 373:1352-1363.
• [24]Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, Gatell JM, Günthard HF, Hammer SM, Hirsch MS, Jacobsen DM, Reiss P, Richman DD, Volberding PA, Yeni P, Schooley RT: Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. JAMA 2010, 304:321-333.
• [25]Panel de expertos de Gesida y Plan Nacional sobre el Sida: Recomendaciones de GESIDA/Plan Nacional sobre el Sida infectados por el virus de la inmunodeficiencia humana (Actualización enero 2010). Enferm Infecc Microbiol Clin 2010, 28:362-391.
• [26]European AIDS Clinical Society: Treatment guidelines (EACS). [http:/ / www.europeanaidsclinicalsociety.org / images/ stories/ EACS-Pdf/ eacs-euroguidelines_fullversion.pdf] webcite Accessed March 2011
• [27]Antiretroviral therapy cohort collaboration (ART-CC), Lanoy E, May M, Mocroft A, Phillip A, Justice A, Chêne G, Furrer H, Sterling T, Monforte AD, Force L, Gill J, Harris R, Hogg RS, Rockstroh J, Saag M, Khaykin P, de Wolf F, Sterne JA, Costagliola D: 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. AIDS 2009, 23:2199-2208.
• [28]Moore DM, Harris R, Lima V, Hogg B, May M, Yip B, Justice A, Mocroft A, Reiss P, Lampe F, Chêne G, Costagliola D, Elzi L, Mugavero MJ, Monforte AD, Sabin C, Podzamczer D, Fätkenheuer G, Staszewski S, Gill J, Sterne JA, Antiretroviral Therapy Cohort Collaboration: Effect of baseline CD4 cell counts on the clinical significance of short-term immunologic response to antiretroviral therapy in individuals with virologic suppression. J Acquir Immune Defic Syndr 2009, 52:357-363.
• [29]Borghi V, Girardi E, Bellelli S, Angeletti C, Mussini C, Porter K, Esposito R: Late presenters in an HIV surveillance system in Italy during the period 1992-2006. J Acquir Immune Defic Syndr 2008, 49:282-286.
• [30]Centers for Disease Control and Prevention (CDC): Vital signs: HIV testing and diagnosis among adults--United States, 2001-2009. MMWR Morb Mortal Wkly Rep 2010, 59:1550-1555.
• [31]Blanco JR, Caro AM, Pérez-Cachafeiro S, Gutiérrez F, Iribarren JA, González-García J, Ferrando-Martínez S, Navarro G, Moreno S: HIV Infection and Aging. AIDS Rev 2010, 12:218-230.
• [32]Althoff KN, Gebo KA, Gange SJ, Klein MB, Brooks JT, Hogg RS, Bosch RJ, Horberg MA, Saag MS, Kitahata MM, Eron JJ, Napravnik S, Rourke SB, Gill MJ, Rodriguez B, Sterling TR, Deeks SG, Martin JN, Jacobson LP, Kirk GD, Collier AC, Benson CA, Silverberg MJ, Goedert JJ, McKaig RG, Thorne J, Rachlis A, Moore RD, Justice AC, for the North American AIDS Cohort Collaboration on Research and Design: CD4 count at presentation for HIV care in the United States and Canada: Are those over 50 years more likely to have a delayed presentation? [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022663/pdf/1742-6405-7-45.pdf] webciteAIDS Res Ther 2010, 7:45. Accessed March 2011
• [33]Manavi K, McMillan A, Ogilvie M, Scott G: Heterosexual men and women with HIV test positive at a later stage of infection than homo- or bisexual men. Int J STD AIDS 2004, 15:811-814.
• [34]Centers for Disease Control and Prevention (CDC): Late versus early testing of HIV--16 Sites, United States, 2000-2003. MMWR 2003, 52:581-586.
• [35]Sabin CA, Smith CJ, Gumley H, Murphy G, Lampe FC, Phillips AN, Prinz B, Youle M, Johnson MA: Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy. AIDS 2004, 18:2145-2151.
• [36]Castelnuovo B, Chiesa E, Rusconi S, Adorni F, Bongiovanni M, Melzi S, Cicconi P, Tordato F, Meroni L, Bini T, d'Arminio Monforte A: Declining incidence of AIDS and increasing prevalence of AIDS presenters among AIDS patients in Italy. Eur J Clin Microbiol Infect Dis 2003, 22:663-669.
• [37]Hibbard JH, Pope CR: Gender roles, illness orientation and use of medical services. Soc Sci Med 1983, 17:129-137.
• [38]Girardi E, Aloisi MS, Arici C, Pezzotti P, Serraino D, Balzano R, Vigevani G, Alberici F, Ursitti M, D'Alessandro M, d'Arminio Monforte A, Ippolito G, for the ICoNA Behavioural Epidemiology Study Group: Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy. J Acquir Immune Defic Syndr 2004, 36:951-959.
• [39]Ndiaye B, Salleron J, Vincent A, Bataille P, Bonnevie F, Choisy P, Cochonat K, Fontier C, Guerroumi H, Vandercam B, Melliez H, Yazdanpanah Y: Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007. [http://www.biomedcentral.com/content/pdf/1471-2334-11-11.pdf] webciteBMC Infect Dis 2011, 11:11. Accessed March 2011 BioMed Central Full Text
• [40]Grigoryan A, Hall HI, Durant T, Wei X: Late HIV diagnosis and determinants of progression to AIDS or death after HIV diagnosis among injection drug users, 33 US States, 1996-2004. PLoS One 2009, 4:e4445.
• [41]Larson BA, Brennan A, McNamara L, Long L, Rosen S, Sanne I, Fox MP: Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa. Bull World Health Organ 2010, 88:675-680.
• [42]Gatell JM, Zulaica D, del Romero J, Robledo T: Cómo promover y facilitar el diagnóstico precoz de la infección por el VIH-1. Enf Emerg 2010, 12:121-124.
• [43]Girardi E, Sabin CA, Monforte AD: Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr 2007, 46(Suppl 1):S3-S8.
• [44]Delpierre C, Cuzin L, Lauwers-Cances V, Marchou B, Lang T: High-Risk groups for late diagnosis of HIV infection: a need for rethinking testing policy in the general population. AIDS Patient Care STDS 2006, 20:838-847.