title: Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France.
abstract: Correlates of late presentation (LP) for HIV infection in Metropolitan France and French overseas departments (FODs) were assessed among HIV-infected patients recently diagnosed, using data from a large cross-sectional survey, representative of the French HIV-infected population, conducted in 2011. LP was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 < 350/mm(3) and presentation with advanced disease (PAD) was defined as presentation with either clinical AIDS events or CD4 < 200/mm(3). Correlates of LP/PAD were assessed through logistic modelling, separately in Metropolitan France and FODs. In Metropolitan France, 47.7% of participants were late presenters and 29.3% presented with advanced disease. LP was more frequent among male and female migrants from sub-Saharan Africa (SSA; 58.5% and 56.4%) and non-African heterosexual males (61.8%) than among men who have sex with men (34.8%). In FODs, 53.2% of participants were late presenters and 36.8% presented with an advanced disease. LP was more frequent among men than women (60.6% vs. 45.3%) and among those with a lower level of education (56.6% vs. 47.5%). A consistent positive association was found in adjusted analyses between LP/PAD and increasing age at diagnosis among all subpopulations, in both settings. In Metropolitan France, among men who have sex with men, those self-declaring as bisexual were at higher risk of LP/PAD; among non-African heterosexual males and females, religiosity was associated with increased risk of LP/PAD; and among SSA migrants, those diagnosed within the year following their arrival in France were at higher risk of LP/PAD. Older age at diagnosis is a major risk factor for LP/PAD independently of any other socio-demographic characteristics. Promotion of HIV testing should be renewed to target each subgroup at risk while paying a particular attention to middle-aged or older adults whose attitudes and beliefs towards HIV/AIDS might prevent them from seeking testing.
authors.affiliation: a Department of Social Epidemiology, INSERM, UMR_S 1136 , Pierre Louis Institute of Epidemiology and Public Health , Paris , France.
authors.forename: Kayigan d'Almeida
authors.initials: Kd
authors.lastname: Wilson
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.forename: Cindy
authors.initials: C
authors.lastname: Aubrière
authors.forename: Christine
authors.initials: C
authors.lastname: Hamelin
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: France
authors.initials: F
authors.lastname: Lert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014505:Urban Population
keywords: France; HIV; late presentation; older age; screening