title: Determinants of late-stage HIV disease at diagnosis in Singapore, 1996 to 2009.
abstract: BACKGROUND
  The delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies.
  
  
  METHODS
  We included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009. Late-stage HIV infection is defined as CD4 count less than 200 mm(3) or AIDS-defining opportunistic infections at fi rst diagnosis or within one year of HIV diagnosis. We determined independent epidemiological risk factors for late-stage HIV infection at first diagnosis using multivariate logistic regression.
  
  
  RESULTS
  Multivariate analysis showed that older age corresponded significantly with increasing odds of late-stage HIV infection. Compared to persons diagnosed at 15 to 24 years of age, those diagnosed at age 55 years and above were associated with 5-fold increased likelihood of late-stage infection (adjusted odds ratio (AOR): 5.17; 95% CI, 3.21 to 8.33). Chinese ethnicity, singlehood, and non-professional occupations were also significantly associated with late-stage HIV infection. Persons detected in the course of medical care had over 3.5 times the odds of late-stage infection (AOR: 3.55; 95% CI, 2.71 to 4.65). Heterosexual mode of transmission and having sex workers and social escorts as sexual partners, were the other epidemiological risk factors with significant associations.
  
  
  CONCLUSIONS
  The findings of this study emphasises the need to increase HIV awareness and to encourage early and regular HIV testing among at-risk persons.
authors: Epidemiology and Disease Control Division, Ministry of Health, Singapore. jeannie_tey@moh.gov.sg
authors: Jeannie S H
authors: JS
authors: Tey
authors: Li Wei
authors: LW
authors: Ang
authors: Joanne
authors: J
authors: Tay
authors: Jeffery L
authors: JL
authors: Cutter
authors: Lyn
authors: L
authors: James
authors: Suok Kai
authors: SK
authors: Chew
authors: Kee Tai
authors: KT
authors: Goh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D018563:Disease Notification; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012846:Singapore / Q000453:epidemiology