Factors associated with late presentation of HIV infection in Catalonia, Spain

Abstract

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend (P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

Predictors of Delayed Diagnosis and Evolution in Sub-Saharan Immigrants with HIV Infection in a Hospital in Madrid (2004–2013)

“…This association has also been found in other studies [6,7,14,19,21] in addition to a lower level of education (a surrogate marker of socioeconomic status) [24,25]. In a study in London, a sub-Saharan origin was associated with a two-fold higher risk of diagnosis with advanced disease than the natives after adjusting for gender and risk group [5].…”

“…The difference between the studies may be due to the different origins of the immigrants. In the majority of the studies in Spain and Europe, immigrants, especially Africans, are diagnosed later than the autochthonous population [4][5][6][7]14,21,22]. When we analyzed only the sub-Saharan subset, the delayed diagnosis results from Spain were similar to those of our study [3].…”

“…Although some studies have observed a decrease in delayed diagnosis over time [6,14,20], this trend remained stable in other studies, including ours [19,21]. This decline has only been demonstrated among homosexuals [3,6,14] and not among subSaharans [5], and an increase has been observed among women infected through heterosexual transmission in the countries of southern Europe [21].…”

“…This figure was much higher than is typically observed in other Spanish areas [14] with some exceptions [15]. Immigrants of sub-Saharan origin represented almost two-thirds of the total immigrants.…”

“…The sub-Saharan patients were the only group in which women and heterosexual transmission predominated, which has been observed in many studies [4,10,14].…”