title: Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009.
abstract: BACKGROUND
  Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.
  
  
  METHODS
  Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.
  
  
  RESULTS
  Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).
  
  
  CONCLUSIONS
  Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.
authors: Epidemiology Service, Agencia de Salut Pública de Barcelona, Barcelona, Spain. polalla@aspb.cat.
authors: Patricia Garcia
authors: PG
authors: de Olalla
authors: Christian
authors: C
authors: Manzardo
authors: Maria A
authors: MA
authors: Sambeat
authors: Inma
authors: I
authors: Ocaña
authors: Hernando
authors: H
authors: Knobel
authors: Victoria
authors: V
authors: Humet
authors: Pere
authors: P
authors: Domingo
authors: Esteve
authors: E
authors: Ribera
authors: Ana
authors: A
authors: Guelar
authors: Andres
authors: A
authors: Marco
authors: Maria J
authors: MJ
authors: Belza
authors: Josep M
authors: JM
authors: Miró
authors: Joan A
authors: JA
authors: Caylà