title: Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004-2013.
abstract: OBJECTIVE
  To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013).
  
  
  METHODS
  Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS.
  
  
  RESULTS
  Of 7165 new HIV diagnoses, 46.9% (CI95%:45.7-48.0) were LP, 240 patients died. First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5-19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2-3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7-3.1). First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004-05) to 39.4% (2012-13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women. Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2-1.7]); age (OR31-40.vs.<30 = 1.6[1.4-1.8], OR41-50.vs.<30 = 2.2[1.8-2.6], OR>50.vs.<30 = 3.6[2.9-4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0-3.8]; ORHeterosexual.vs.MSM = 2.2[1.7-3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1-2.0], ORLowerSecondary.vs.University = 1.3[1.1-1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3-2.0], ORLatin-American.vs.Spain = 1.4[1.2-1.8]).
  
  
  CONCLUSIONS
  LP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women.
authors.affiliation: Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address: psobrino@isciii.es.
authors.forename: Paz
authors.initials: P
authors.lastname: Sobrino-Vegas
authors.affiliation: Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.affiliation: Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.affiliation: Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Pompeyo
authors.initials: P
authors.lastname: Viciana
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Bernardino
authors.affiliation: Hospital San Pedro, La Rioja, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Blanco
authors.affiliation: Hospital General Universitario Reina Sofía, Murcia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Asensi
authors.affiliation: Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Pulido
authors.affiliation: Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.affiliation: Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hernando
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
keywords: Causes of death; Cohort study; Factors and trends; HIV; Late presentation; Mortality