Late presentation of HIV infection: predictors of delayed diagnosis and survival in Eastern Sicily

OBJECTIVES: Across Europe, more than one third of patients are diagnosed with HIV infection late. Late presentation for care has been associated with higher risk of clinical progression and mortality. In the present study, we evaluated theprevalence, epidemiological characteristics and survival probability of patients with late and very late presentation, newly diagnosed with HIV infection inCatania, Italy, from 1985 to 2010.PATIENTS AND METHODS: According to the European Consensus definition, LatePresenters (LP) were defined as subjects presenting for care with a CD4+ T-cellcount below 350 cells/µl or with an AIDS-defining event, regardless of CD4+T-cell count; patients with advanced HIV disease (Very Late Presenters) (VLP)were those presenting with a CD4+ T-cell count below 200 cells/µl or with an AIDS-defining event, regardless of CD4+ T-cell count.RESULTS: 620 patients were included in the study. 345 (55.6%) subjects were LP,35% of them were asymptomatic; 246 (39.7%) were VLP. In univariate analysis, latepresentation was related to age (p < 0.001), to heterosexual exposure to HIVinfection (70% of heterosexual subjects were LP) (p < 0.005) and to beingdiagnosed during the calendar period from 1991 to 2000 (p < 0.001). Very latepresentation was related to age (p < 0.001), male sex (p < 0.01), heterosexualrisk (p < 0.001) and to being diagnosed during the calendar period from 1991 to2000 (p < 0.001). In multivariate analysis, age (p < 0.0001), being older than 50years old (p = 0.02), years of diagnosis 1991-1995 (p < 0.005) and 1996-2000 (p <0.05) in the subgroup of late presenters and age (p < 0.0001), being older than50 years old (p < 0.005), male sex (p < 0.0001), years of diagnosis 1991-1995 (p < 0.05) and 1996-2000 (p < 0.005) in the subgroup of very late presentersmaintained statistical significance. The survival probability within LP and VLPgroup was statistically lower than no LP/VLP (log rank test p < 0.0005 and p <0.0001, respectively). For both LP (p < 0.002) and VLP (p < 0.0001), survivalprobability was significantly lower in the pre-HAART era, in comparison with the period of mono/dual therapy and the HAART era.CONCLUSIONS: More than fifty percent of patients in our setting were diagnosedlate with HIV infection and, consequently, treated late. Late and very latepresentation were associated with lower survival probability. The implementation of strategies focused on targeted prevention efforts and HIV testing programsappears fundamental to diagnose and treat HIV infection as early as possible.