Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013

Abstract

Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010-2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrollment) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count < 350/mm(3) or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. A total of 30,454 people were included. The median CD4 count at presentation was 368/mm(3) (interquartile range (IQR) 193-555/mm(3)), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02-1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85-0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

“…18 Similar rates of late diagnosis are present all over Europe. 19 In Metropolitan USA, the rate may be somewhat lower but still ranges between 23.3% and 47.7%. 20 In our centre, 33% of the patients were diagnosed late, 16% with AHD.…”

Late presentation among patients with human immunodeficiency virus infection in Turkey

“…The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study including 30,454 patients from 34 countries reported that the median CD4 count at presentation was 368/mm 3 (33). In 2010, 47.5% of the patients had CD4 < 350/mm 3 , while this figure was 48.7% in 2013.…”

Monitoring of HIV testing services in the EU/EEA

“…The European region is increasing its efforts to reach the 90–90–90 targets advocated by the Joint United Nations Programme on HIV/AIDS (UNAIDS) [2]. One of the major challenges many European countries face is the high proportion of undiagnosed people living with HIV [3] and the high rates of late diagnosis [4,5]. In the past years, testing programmes have improved in terms of their accessibility and coverage, yet it remains difficult to monitor and evaluate the performance of testing programmes at all levels as a consequence of significant gaps in the data available on testing services [4,6].…”