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
, Santiago Moreno c, Rafael Rubio d, Pompeyo Viciana e, José Ignacio Bernardino f, José Ramón Blanco g, Enrique Bernal h, Víctor Asensi i, Federico Pulido d, Julia del Amo a, b, 1, Victoria Hernando a, b, 1Cohorte 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 numéro
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