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

Research Article

Fabio Zacchi¹  Andrea Gori²  Elisa Di Filippo³  Franco Maggiolo³  Laura Sighinolfi⁴  Massimo Di Pietro⁵  Maria Concetta Postorino⁶  Carlo Torti⁶  Filippo Castelnuovo⁷  Elena Raffetti⁸  Alessandro D’Avino⁹  Nicoletta Ladisa^1,10  Salvatore Casari^1,11  Francesco Castelli^1,11 

[1] Clinic of Infectious Diseases, Istituti Ospitalieri Cremona, Cremona, Italy;Clinic of Infectious Diseases, Ospedale “S. Gerardo”, Monza, Italy;Clinic of Infectious Diseases, “Papa Giovanni XXIII” Hospital, Bergamo, Italy;Clinic of Infectious Diseases, “S. Anna” Hospital, Ferrara, Italy;Clinic of Infectious Diseases, “S. M. Annunziata” Hospital, Florence, Italy;Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University “Magna Graecia”, Catanzaro, Italy;Infectious Diseases, Spedali Civili Hospital, Brescia, Italy;Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy;Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy;Institute of Infectious Diseases, University of Bari, Bari, Italy;Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy;

关键词: HIV infection;    AIDS;    Late diagnosis;    Late presentation;    Advanced HIV disease;   

DOI  :  10.1186/s12889-016-3477-z

 received in 2016-03-06, accepted in 2016-08-10,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundWe aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.MethodsAll antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.Results19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004–2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.ConclusionScreening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.

【 授权许可】

CC BY   
© The Author(s). 2016