title: Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain.
abstract: OBJECTIVE
  To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants.
  
  
  METHODS
  We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP.
  
  
  RESULTS
  A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men.
  
  
  CONCLUSIONS
  Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care.
authors.affiliation: Plan Nacional sobre el Sida/Centro Nacional de Epidemiología, Unidad de Epidemiología del VIH/SIDA y Conductas de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: jaoliva@isciii.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oliva
authors.affiliation: Plan Nacional sobre el Sida/Centro Nacional de Epidemiología, Unidad de Epidemiología del VIH/SIDA y Conductas de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Díez
authors.affiliation: Plan Nacional sobre el Sida/Centro Nacional de Epidemiología, Unidad de Epidemiología del VIH/SIDA y Conductas de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Galindo
authors.affiliation: Servicio de Epidemiología, Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cevallos
authors.affiliation: Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Sta. Cruz de Tenerife, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Izquierdo
authors.affiliation: Servizo de Control de Enfermidades Transmisibles, Dirección Xeral de Innovación e Xestión da Saúde Pública, Xunta de Galicia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Cereijo
authors.affiliation: Plan de Prevención y Control del Sida del País Vasco, San Sebastián, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Arrillaga
authors.affiliation: Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Salud y Consumo del Gobierno Balear, Palma de Mallorca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolau
authors.affiliation: Servicio de Vigilancia y Alertas Epidemiológicas, Dirección General Salud Pública y Participación, Consejería de Salud y Servicios Sanitarios del Principado de Asturias, Oviedo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.affiliation: Subdirección de Epidemiología, Servicio Extremeño de Salud, Junta de Extremadura, Mérida, Spain.
authors.forename: Mara
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
authors.affiliation: Servicio de Epidemiología y Prevención Sanitaria, Consejería de Salud del Gobierno de La Rioja, Logroño, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Martínez
authors.affiliation: Servicio de Epidemiología, Consejería de Sanidad y Consumo de la Ciudad Autónoma de Ceuta, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: López
authors.affiliation: Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Institut Català d'Oncologia (ICO), Direcció General de Salut Pública, Generalitat de Catalunya, Badalona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Vivés
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D062486:Public Health Surveillance; D013030:Spain / Q000453:epidemiology
keywords: Advanced disease; Enfermedad avanzada; España; HIV; Late presentation; Presentación tardía; Spain; Surveillance; VIH; Vigilancia epidemiológica