Characteristics of late presenters in Bucharest

Abstract

IntroductionLate presentation is associated with increased healthcare costs, rates of HIV transmission and poor outcome. In Romania, in 2012, one third of individuals with new HIV diagnosis were late presenters (LP).ObjectiveThe aim of the study was to evaluate the epidemiological and clinical characteristics associated with late presentation.MethodsWe retrospectively studied patients over 18 years old, notified in our institution between January 2012 and December 2013, including 499 out of 727 newly diagnosed patients in Bucharest. LP were defined as patients presenting with CD4 T-cell count below 350 cells/mm3 or with an AIDS defining event. Patients with advanced HIV disease (AHD) were defined as persons with a CD4 T-cell count below 200 cells/mm3. Differences between groups were analyzed using the Mann-Whitney U test for continuous variables and the chi-square test for dichotomous variables. Multivariable analysis was performed using binary logistic regression.ResultsOut of 499 patients included, 362 (72%) were male. The median age was 30 (IQR 26–36). A total of 302 (61%) were LP and 184 (37%) were patients with AHD. A total of 170 (34%) were asymptomatic and 114 (23%) presented with an AIDS-defining event. The median CD4 count was 293 cells/mm3 (IQR 125–471) and the median HIV viral load was 100,191 copies/mL (IQR 34,560–272,936). Characteristics of LP compared with non-LP are shown in Table 1. Stage C disease has been shown by multivariable analysis to be associated with LP (p<0.001, OR=11.56, 95% CI 4.94–27.03).ConclusionsMore than half of newly HIV diagnosed patients in Bucharest were LP. The proportion of LP was highest among heterosexually acquired cases. Although most our patients were young, late presentation was associated with age over 35 years. The lower proportion of LP among IVDU compared with those heterosexually infected could be explained by a higher proportion of HIV screening tests among IVDU.

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

“…In our study, late presentation and advanced HIV disease were more frequent among patients entering care in the older age groups, female patients, those who were heterosexually infected and IDUs. Reports from Romania and Denmark are consistent with our observation that a significantly higher proportion of heterosexual patients, compared with the MSM group, are late presenters . In our study, the odds of late care entry and advanced HIV disease increased consistently with age.…”

Gender difference in advanced HIV disease and late presentation according to European consensus definitions

“…Previous studies showed that males were more likely to present late in HIV diagnosis 25 26 , while some other studies presented no significant difference between males and females in late HIV diagnosis 27 28 . These conflicting reports are reflective of the difference in health-seeking behaviors and HIV testing policies, as well as the heterogeneity of the parameters used among the different studies.…”

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

“…The reason is that the screening campaigns that were carried out targeted mainly young people and offered very little opportunities for old people to be screened early. The reason was that old people were perceived to be at lower risks of being HIV-positive, but they were often infected when they were young and the diagnosis was not made [21]. Moreover, practitioners performed HIV screening for young people than elders when they are hospitalized.…”