Factors associated with late presentation for HIV care in a single Belgian reference center: 2006–2017

Abstract

Late presentation for HIV care is a major issue and the cause of higher morbidity, mortality and transmission. In this regard, we analyzed the characteristics of patients presenting for care at our center from January 2006 to July 2017 (n = 687). The majority of the studied population was of African origin (54.3%) with heterosexual women representing the main group (n = 292; 42.5%). 44% of the patients were late presenters (LP) (presenting for care with CD4 T cells <350/mm3 or an AIDS defining event) and 24% were late presenters with advanced disease (LP-AD) (presenting for care with CD4 T cells <200/mm3 or an AIDS defining event). A very high risk of being LP and LP-AD was associated with Sub-Saharan origin (OR 3.4 and 2.6 respectively). Other factors independently associated with LP or LP-AD were age (OR 1.3), male gender (OR 2.0 and 1.5 respectively) and heterosexual route of transmission (OR 2.4 and 2.3 respectively). A significant increase in HIV screening without forgetting those groups would contribute to earlier HIV diagnosis, a key element to end the HIV epidemic. To achieve this goal, addressing the specific hurdles to HIV testing in the migrant population is critical.

Socio-demographic and clinical determinants of late presentation among patients newly diagnosed with HIV in the Eastern Cape, South Africa

“…This finding is in contrast to a study conducted in Denmark, which reported that no association existed between level of education and late presentation for HIV care. [39] Considering that Denmark is among countries with the highest levels of literacy, that finding is not comparable with the finding in this study. In addition, lower level of education was found to be associated with late presentation among newly diagnosed patients in other studies.…”

“…In this study, male gender was found to be an independent predictor of late presentation for HIV diagnosis. This finding is consistent with previous studies, [26,39] although an Ethiopian study reported a contrasting result, with females significantly more likely to be late presenters. [40] A study in China found no sex differences in the CD4 counts of newly diagnosed HIV-infected patients.…”

“…Our study also shows that older age is associated with late diagnosis of HIV, which is consistent with findings in previous studies, [36,39,40] although it contrasts with findings in a study conducted in China. [31] Even though the effect of age on late presentation disappeared after controlling for other covariates, the consistency in the direction of the effect, as shown in the literature, suggests older age is a risk factor for late presentation for HIV diagnosis and care.…”

Long‐term trends in HIV care entry: over 15 years of clinical experience from Poland

“…Independent risk factors for late presentation in that Spanish cohort were increased age, heterosexual male transmission route, injecting drug use and being born in South America or sub‐Saharan Africa (SSA) . In several countries across Western Europe, delayed presentation to care was more frequent in the group of immigrants from sub‐Saharan Africa . In Poland, the number of immigrants from countries with a high prevalence of HIV infection is low, but in recent years an influx of immigrants from Eastern Europe, especially from Ukraine, has been observed .…”

Impact of coronavirus pandemic and containment measures on HIV diagnosis

“…Moreover, the symptoms related to HIV infection could have been misinterpreted as caused by SARS-CoV-2. High rates of missed opportunities for HIV diagnosis have previously been reported, highlighting the ongoing need for physician education on HIV testing and clinical signs suggestive of HIV infection [1, 2]. This is likely to be exacerbated in the context of COVID-19 pandemic.…”