Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study

Identifier:  imarina:9296786

Handle: https://hdl.handle.net/20.500.11797/imarina9296786

Authors:  Berenguer, Juan; Bohlius, Julia; Bouteloup, Vincent; Bucher, Heiner; Cozzi-Lepri, Alessandro; Dabis, Francois; Monforte, Antonella d'Arminio; Davies, Mary-Anne; del Amo, Julia; Dorrucci, Maria; Dunn, David; Egger, Matthias; Furrer, Hansjakob; Guiguet, Marguerite; Grabar, Sophie; Judd, Ali; Kirk, Ole; Lambotte, Olivier; Leroy, Valeriane; Lodi, Sara; Matheron, Sophie; Meyer, Laurence; Miro, Jose M.; Mocroft, Amanda; Monge, Susana; Nakagawa, Fumiyo; Paredes, Roger; Phillips, Andrew; Puoti, Massimo; Schomaker, Michael; Smit, Colette; Sterne, Jonathan; Thiebaut, Rodolphe; Thorne, Claire; Torti, Carlo; van der Valk, Marc; Wittkop, Linda; Wyss, Natasha; Late Presenters Working Grp COHERE

Abstract:
Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010-2013. People aged >= 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrolment) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count < 350/mm(3) or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. A total of 30,454 people were included. The median CD4 count at presentation was 368/mm(3) (interquartile range (IQR) 193-555/mm(3)), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02-1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85-0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.