Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

• Published in: PLoS medicine Vol. 10; no. 9; p. e1001510
• Main Authors: Mocroft, Amanda, Lundgren, Jens D, Sabin, Miriam Lewis, Monforte, Antonella d'Arminio, Brockmeyer, Norbert, Casabona, Jordi, Castagna, Antonella, Costagliola, Dominique, Dabis, Francois, De Wit, Stéphane, Fätkenheuer, Gerd, Furrer, Hansjakob, Johnson, Anne M, Lazanas, Marios K, Leport, Catherine, Moreno, Santiago, Obel, Niels, Post, Frank A, Reekie, Joanne, Reiss, Peter, Sabin, Caroline, Skaletz-Rorowski, Adriane, Suarez-Lozano, Ignacio, Torti, Carlo, Warszawski, Josiane, Zangerle, Robert, Fabre-Colin, Céline, Kjaer, Jesper, Chene, Genevieve, Grarup, Jesper, Kirk, Ole
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.09.2013; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Care and treatment; CD4 Lymphocyte Count; Collaboration; Cooperative Behavior; Disease Progression; Europe - epidemiology; Female; HIV; HIV infection; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - immunology; HIV patients; HIV Seropositivity - epidemiology; Host-parasite relationships; Human immunodeficiency virus; Humans; Illnesses; Immune system; Incidence; Infections; Male; Medical tests; Medicine; Mortality; Patient outcomes; Risk Factors; Sensitivity and Specificity; Studies; Substance Abuse, Intravenous - epidemiology; Time Factors; Treatment Outcome; Europe; United States; Africa; HIV Infections; HIV Seropositivity; Sensitivity & Specificity; Europe; Humans; Risk Factors; Cooperative Behavior; Male; Treatment Outcome; CD4 Lymphocyte Count; Substance Abuse, Intravenous; Disease Progression; Incidence; Time Factors; Female
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1001510

Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm(3) or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95-0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19-20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55-12.43). LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.