Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome.
BACKGROUND
To study the prevalence, predictors and outcome of late HIV diagnosis in the Icona cohort, according to the new European consensus definition of late diagnosis.


METHODS
In this observational cohort study we investigated patients diagnosed with HIV over 3 months preceding enrolment who were defined as diagnosed late if they presented with AIDS or a CD4(+) T-cell count ≤ 350/mm³ (European consensus definition). We estimated the prevalence of late diagnosis, identified factors associated with being diagnosed late and looked at the prognostic value of the European consensus definition of late presentation to predict subsequent clinical progression (new AIDS events or death).


RESULTS
In total, 1,438/2,276 patients (63%) were defined as diagnosed late using the new European Consensus definition. Of these, 387 (16%) were AIDS-presenters. Predictors of being diagnosed late were older age, non-Italian origin, high HIV RNA and unemployment (versus retirement). A total of 293 patients showed clinical progression (3 events/100 person-years of follow-up, 95% CI: 2.7-3.4). Presenting late was strongly associated with a >5-fold increased risk of disease progression.


CONCLUSIONS
In our observational setting with free access to care, more than 60% of new HIV diagnoses occurred below the recommended threshold for initiating antiretroviral treatment. Presenting late for care was associated with a high risk of clinical progression.
Clinic of Infectious and Tropical Diseases, Department of Medicine, Surgery and Dentistry, S Paolo Hospital, University of Milan, Milan, Italy. antonella.darminio@unimi.it
Antonella
A
d'Arminio Monforte
Alessandro
A
Cozzi-Lepri
Enrico
E
Girardi
Antonella
A
Castagna
Cristina
C
Mussini
Simona
S
Di Giambenedetto
Massimo
M
Galli
Giovanni
G
Cassola
Vincenzo
V
Vullo
Eugenia
E
Quiros-Roldan
Sergio
S
Lo Caputo
Andrea
A
Antinori
D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
D012367:RNA, Viral