Association of demographics, HCV co‐infection, HIV‐1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV‐1 Surveillance Network

Abstract

Introduction Late diagnosis of the human immunodeficiency virus (HIV) is a major concern epidemiologically, socially and for national healthcare systems. Although the association of certain demographics with late HIV diagnosis has been reported in several studies, the association of other factors, including clinical and phylogenetic factors, remains unclear. In the present study, we conducted a nationwide analysis to explore the association of demographics, clinical factors, HIV‐1 subtypes/circulating recombinant form (CRFs) and genetic clustering with late HIV diagnosis in Japan, where new infections mainly occur among young men who have sex with men (MSM) in urban areas. Methods Anonymized data on demographics, clinical factors and HIV genetic sequences from 39.8% of people newly diagnosed with HIV in Japan were collected by the Japanese Drug Resistance HIV‐1 Surveillance Network from 2003 to 2019. Factors associated with late HIV diagnosis (defined as HIV diagnosis with a CD4 count <350 cells/μl) were identified using logistic regression. Clusters were identified by HIV‐TRACE with a genetic distance threshold of 1.5%. Results Of the 9422 people newly diagnosed with HIV enrolled in the surveillance network between 2003 and 2019, 7752 individuals with available CD4 count at diagnosis were included. Late HIV diagnosis was observed in 5522 (71.2%) participants. The overall median CD4 count at diagnosis was 221 (IQR: 62–373) cells/μl. Variables independently associated with late HIV diagnosis included age (adjusted odds ratio [aOR] 2.21, 95% CI 1.88–2.59, ≥45 vs. ≤29 years), heterosexual transmission (aOR 1.34, 95% CI 1.11–1.62, vs. MSM), living outside of Tokyo (aOR 1.18, 95% CI 1.05–1.32), hepatitis C virus (HCV) co‐infection (aOR 1.42, 95% CI 1.01–1.98) and not belonging to a cluster (aOR 1.30, 95% CI 1.12–1.51). CRF07_BC (aOR 0.34, 95% CI 0.18–0.65, vs. subtype B) was negatively associated with late HIV diagnosis. Conclusions In addition to demographic factors, HCV co‐infection, HIV‐1 subtypes/CRFs and not belonging to a cluster were independently associated with late HIV diagnosis in Japan. These results imply the need for public health programmes aimed at the general population, including but not limited to key populations, to encourage HIV testing.

Population-based nanopore sequencing of the HIV-1 pangenome to identify drug resistance mutations

“…No sample displayed any mixed heterologous subtypes. This subtype trend is similar to the recent epidemic report throughout Japan 16 .

Figure 2 Success and failure rates of HIV-1 pangenome amplification via RT–PCR and nested PCR for clinical samples (n = 121) with different viral loads.

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Risk Factors for Late HIV Presentation in Patients Treated at a Single Belgian Reference Centre from 2018 to 2022

“…Other studies performed during a similar timeframe (2017 to 2020, 2019 to 2020 and 2015 to 2020) also revealed that male and older patients are at greater risk of late HIV presentation [ 23 , 24 , 25 ]. Additionally, other LP risk factors, including bisexual transmission, heterosexual transmission, being married, SSA origin, tuberculosis or hepatitis C virus coinfection, lower socioeconomic status and the fear of stigma, have been reported in various studies [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The discrepancies observed among those studies highlight the importance of identifying populations at risk of late presentation and developing specific guidelines according to the region.…”