The evolving mode of presentation of HIV-infected patients to health services of northern Spain: 1985 through December 1999.

To evaluate the mode in which human immunodeficiency virus (HIV)-infected patients have had their first contact with the health services throughout time as well as their demographic and immunologic features, all 1,076 adult HIV-infected patients seen at our institution were grouped by the year of presentation. The patients' age and gender, the mode of presentation (admitted through the emergency department or seen at the outpatient clinic), and the presence of acquired immune deficiency syndrome (AIDS)-defining conditions and CD4 counts at the time of presentation were analyzed. The patients' age at presentation and the rate of female patients increased throughout time (p < 0.001, and p = 0.01, respectively). There was a progressive decline in the proportion of patients who were hospitalized until the mid-1990s (p < 0.0001), followed by a rise during the subsequent years (p = 0.04). This U-shaped curve was opposite to that of CD4 counts, which was ascending until 1994 (p = 0.04), to decline progressively later (p = 0.1). Patients whose first contact with the hospital was through admission had lower CD4 counts (p = 0.007), and higher rates of AIDS diagnosis throughout time (p < 0.0001). We conclude that some features of HIV-infected patients at the time of their first contact with the health services are changing over time, such as older age, increasing numbers of women, and higher degrees of immunosuppression. These findings seem to reflect the increasing number of patients unaware of their past risk factors, and should be considered for the development of strategies targeted to this population in order to allow earlier detection of their infection.