title: The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort.
abstract: We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.
  
  
  
  All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.
  
  
  
  19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.
  
  
  
  Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.
authors.affiliation: Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Raffetti
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Postorino
authors.affiliation: Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.affiliation: Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Casari
authors.affiliation: Infectious Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castelnuovo
authors.affiliation: Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Di Filippo
authors.affiliation: Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Avino
authors.affiliation: Clinic of Infectious Diseases, Ospedale "S. Gerardo", Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gori
authors.affiliation: Institute of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ladisa
authors.affiliation: Clinic of Infectious Diseases, "S. M. Annunziata" Hospital, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Clinic of Infectious Diseases, "S. Anna" Hospital, Ferrara, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sighinolfi
authors.affiliation: Clinic of Infectious Diseases, Istituti Ospitalieri Cremona, Cremona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zacchi
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy. torti@unicz.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
mesh_terms: D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D020010:Heterosexuality / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: AIDS; Advanced HIV disease; HIV infection; Late diagnosis; Late presentation