title: Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996-2014: results from a national observational cohort.
abstract: OBJECTIVE
  Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands.
  
  
  METHODS
  HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined.
  
  
  RESULTS
  Of 20,965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥ 50 years (1.46; CI 1.33 to 1.60 vs 30-49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease.
  
  
  CONCLUSIONS
  Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥ 50 years and certain regions in the Netherlands.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Eline L M
authors.initials: EL
authors.lastname: Op de Coul
authors.affiliation: Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.affiliation: Department of Internal Medicine, OLVG, Amsterdam, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Birgit H
authors.initials: BH
authors.lastname: van Benthem
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Marchina E
authors.initials: ME
authors.lastname: van der Ende
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Geerlings
authors.affiliation: Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D057210:Delayed Diagnosis; D018450:Disease Progression; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D058006:General Practice; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology; D015438:Health Behavior; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011295:Prenatal Care; D012307:Risk Factors; D019529:Sexuality; D014171:Transients and Migrants; D055815:Young Adult
keywords: EPIDEMIOLOGY