Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013 - 14/04/16
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Cohorte de la Red de Investigación en Sida, Spain2
Summary |
Objectives |
To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004–2013).
Methods |
Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS.
Results |
Of 7165 new HIV diagnoses, 46.9% (CI95%:45.7–48.0) were LP, 240 patients died.
First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5–19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2–3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7–3.1).
First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004–05) to 39.4% (2012–13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women.
Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2–1.7]); age (OR31–40.vs.<30 = 1.6[1.4–1.8], OR41–50.vs.<30 = 2.2[1.8–2.6], OR>50.vs.<30 = 3.6[2.9–4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0–3.8]; ORHeterosexual.vs.MSM = 2.2[1.7–3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1–2.0], ORLowerSecondary.vs.University = 1.3[1.1–1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3–2.0], ORLatin-American.vs.Spain = 1.4[1.2–1.8]).
Conclusions |
LP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Late presentation of HIV (LP) is associated with higher mortality. |
• | Short-mid-term mortality is higher in LP, without differences in long-term mortality. |
• | LP is associated with short-term mortality due to HIV/AIDS. |
• | Malignancies were the main cause of death among patients who survived >4 years. |
• | LP is higher among non-Spanish, low educated, and heterosexual women. |
Keywords : Late presentation, HIV, Mortality, Factors and trends, Causes of death, Cohort study
Plan
Vol 72 - N° 5
P. 587-596 - mai 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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