Frequency, determinants and consequences of delayed access to care for HIV infection in France.
OBJECTIVE
We analysed the frequency and predictors of delayed access to care (DAC) for HIV infection, and its influence on survival.


METHODS
We studied predictors of DAC among 18,721 patients enrolled between 1997 and 2002 in the French Hospital Database on HIV (FHDH), DAC being defined by a CD4* T-cell count below 200 copies/mm3 and/or AIDS at FHDH enrollment. The association of DAC with the initiation of combined antiretroviral therapy (cART) and of DAC with survival were analysed with Cox multivariable models.


RESULTS
The overall prevalence of DAC was 35.7%. Compared with patients under 30 years of age, patients over 60 were 3.5 times more likely to have DAC (P < 10(-4)). Compared with non-migrant women, odds ratios (OR) of DAC were higher among migrant women (1.5), non-migrant men (1.6) and migrant men (1.9; all P < 10(-4)). Compared with men who have sex with men, other transmission groups had an estimated OR for DAC of 1.6 (P < 10(-4)). DAC was more frequent among patients with a recent diagnosis of HIV infection [OR = 1.3, 95% confidence intervals (CI) = (1.2;1.4)]. Patients with DAC received cART earlier than other patients [hazard ratio (HR) = 2.2, 95% CI = (2.1;2.3)]. The DAC/mortality HR was 13.9 in the first 6 months after enrollment in the FHDH, and remained significantly higher than 1 during the subsequent 4 years.


CONCLUSIONS
DAC is common in France and was associated with a higher mortality, despite early initiation of cART. Earlier access to care and specific clinical management of patients with DAC should be considered.
Lanoy
Emilie
E
INSERM, UMR S 720, Paris, France.
Mary-Krause
Murielle
M
Tattevin
Pierre
P
Perbost
Isabelle
I
Poizot-Martin
Isabelle
I
Dupont
Caroline
C
Costagliola
Dominique
D
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D019992:Databases as Topic; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D018451:Homosexuality, Male; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014171:Transients and Migrants; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents