Marta Rava1, Lourdes Domínguez-Domínguez2, Otilia Bisbal2, Luis Fernando López-Cortés3, Carmen Busca4, Antonio Antela5, Patricia González-Ruano6, Cristina Hernández7, Josè-Antonio Iribarren8, Rafael Rubio2, Santiago Moreno9, Inmaculada Jarrín1. 1. Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain. 2. 12 de Octubre University Hospital, Madrid, Spain. 3. Virgen del Rocío University Hospital, Sevilla, Spain. 4. La Paz University Hospital, Madrid, Spain. 5. University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain. 6. Infanta Sofía University Hospital, Madrid, Spain. 7. Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain. 8. Department of Infectious Diseases, University Hospital, IIS Biodonostia, San Sebastián, Spain. 9. Ramón y Cajal University Hospital, Madrid, Spain.
Abstract
OBJECTIVES: With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. METHODS: CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). RESULTS: 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). CONCLUSIONS: LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
OBJECTIVES: With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. METHODS: CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). RESULTS: 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). CONCLUSIONS:LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
Authors: Lourdes Domínguez-Domínguez; Marta Rava; José Antonio Iribarren; Santiago Moreno; Otilia Bisbal; Luis Lopez-Cortés; Joaquín Portilla; Daniel Podzamczer; Julián Olalla; Daniel Fuster; Rafael Rubio; Inmaculada Jarrín Journal: BMC Infect Dis Date: 2022-04-15 Impact factor: 3.667
Authors: Beatriz Romero-Hernández; Laura Martínez-García; Mario Rodríguez-Dominguez; Javier Martínez-Sanz; Manuel Vélez-Díaz-Pallarés; Belen Pérez Mies; A Muriel; Francisco Gea; María Jesús Pérez-Elías; Juan Carlos Galán Journal: Front Public Health Date: 2022-07-22