title: Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study.
abstract: BACKGROUND
  Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious comorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP and HIV + EP, respectively), and compare them to matched HIV-negative control participants from a community-based cohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in HIV patients.
  
  
  METHODS
  We performed a matched cohort study including HIV + LP and HIV + EP among people attending the Modena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative participants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of ≥2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity.
  
  
  RESULTS
  We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The mean age was 46 ± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the HIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated with increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after adjusting for age, multimorbidity, and antiretroviral costs.
  
  
  CONCLUSIONS
  LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and multimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently needed.
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy. giovanni.guaraldi@unimore.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Menozzi
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Brothers
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Carli
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Stentarelli
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dolci
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Infectious Disease Department, Hospital Beatriz Ângelo, Regiao de Lisboa, Loures, Portugal.
authors.forename: Ana Rita Domingues
authors.initials: AR
authors.lastname: Da Silva
authors.affiliation: Health Care Department, Cineca-Interuniversity Consortium, Casalecchio di Reno, Emilia-Romagna, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rossi
authors.affiliation: McGill University Health Center, Montreal, QC, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Falutz
authors.affiliation: Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
mesh_terms: D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D004469:Economics, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000276:immunology; D017048:Health Care Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: Comorbidities; Costs; HIV; Late presentation