title: Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study.
abstract: BACKGROUND
  Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm3) and mortality.
  
  
  METHODS
  Patients newly diagnosed with HIV infection at a UK clinic were recruited from January 1996 to May 2010. Factors associated with late presentation were assessed using logistic regression. Factors associated with mortality rates were analysed using Poisson regression.
  
  
  RESULTS
  Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mm3 at presentation ("late presentation"). The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual.The mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40).
  
  
  CONCLUSIONS
  Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50.
authors.affiliation: Lawson Unit, Department of HIV/Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK. ciwuji@yahoo.com
authors.forename: Collins C
authors.initials: CC
authors.lastname: Iwuji
authors.forename: Duncan
authors.initials: D
authors.lastname: Churchill
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Gilleece
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
mesh_terms: D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology