title: Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013.
abstract: Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010-2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrollment) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count < 350/mm(3) or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. A total of 30,454 people were included. The median CD4 count at presentation was 368/mm(3) (interquartile range (IQR) 193-555/mm(3)), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02-1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85-0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.
authors.affiliation: a.mocroft@ucl.ac.uk
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Jens
authors.initials: J
authors.lastname: Lundgren
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Johanna
authors.initials: J
authors.lastname: Brännström
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Norbert
authors.initials: N
authors.lastname: Brockmeyer
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Wit
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Corinne
authors.initials: C
authors.lastname: Jadand
authors.forename: Anne
authors.initials: A
authors.lastname: Johnson
authors.forename: Mario
authors.initials: M
authors.lastname: Lazanas
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.forename: Christina
authors.initials: C
authors.lastname: Mussini
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: Frank
authors.initials: F
authors.lastname: Post
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Adriane
authors.initials: A
authors.lastname: Skaletz-Rorowski
authors.forename: Ignacio
authors.initials: I
authors.lastname: Suarez-Loano
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.forename: Linda
authors.initials: L
authors.lastname: Wittkop
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
authors.forename: Genevieve
authors.initials: G
authors.lastname: Chene
authors.forename: Dorthe
authors.initials: D
authors.lastname: Raben
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003299:Cooperative Behavior; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013997:Time Factors
keywords: epidemiology; human immunodeficiency virus - HIV; late presentation