title: [Delayed diagnosis of HIV infection in Spain].
abstract: OBJECTIVE
  To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain.
  
  
  METHODS
  Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/μL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI).
  
  
  RESULTS
  Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/μL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21-1.85). Compared to younger patients (20-29 years), LD was more frequent in older: 30-39 years (OR=2.08; 95% CI:1.63-2.67), 40-49 years (OR=3.98; 95% CI:3.07-5.16) and >49 years (OR=6.77; 95% CI:5.10-9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43-2.15) and IDUs (OR=1.75; 95% CI:1.38-2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08-1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age.
  
  
  CONCLUSIONS
  DD affects almost four in every ten newly diagnosed HIV-infected individuals, and is significantly more common among men, age group over 30 years, IDUs and heterosexuals. These are associated factors both in Spanish and immigrants, but in the last group the association is stronger. Strategies to increase the perception of risk among these groups are needed, as well as the implementation of the SINIVIH in the whole country to improve and to extend the information on DD.
authors.affiliation: Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España. jaoliva@isciii.es
authors.forename: Jesús
authors.initials: J
authors.lastname: Oliva
authors.forename: Silvia
authors.initials: S
authors.lastname: Galindo
authors.forename: Núria
authors.initials: N
authors.lastname: Vives
authors.forename: Arantxa
authors.initials: A
authors.lastname: Arrillaga
authors.forename: Ana
authors.initials: A
authors.lastname: Izquierdo
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolau
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Lezaun
authors.forename: Mara
authors.initials: M
authors.lastname: Alvarez
authors.forename: Ana
authors.initials: A
authors.lastname: Rivas
authors.forename: Mercedes
authors.initials: M
authors.lastname: Díez
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013030:Spain; D055815:Young Adult