Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

Amanda Mocroft, Jens D. Lundgren, Miriam Lewis Sabin, Antonella d'Arminio Monforte, Norbert Brockmeyer, Jordi Casabona, Antonella Castagna, Dominique Costagliola, Francois Dabis, Stéphane De Wit, Gerd Fätkenheuer, Hansjakob Furrer, Anne M. Johnson, Marios K. Lazanas, Catherine Leport, Santiago Moreno, Niels Obel, Frank A. Post, Joanne Reekie, Peter ReissCaroline Sabin, Adriane Skaletz-Rorowski, Ignacio Suarez-Lozano, Carlo Torti, Josiane Warszawski, Robert Zangerle, Céline Fabre-Colin, Jesper Kjaer, Genevieve Chene, Jesper Grarup, Ole Kirk, Amanda Mocroft, Jens Lundgren, Miriam Sabin, Antonella d'Arminio Monforte, Norbert Brockmeyer, Jordi Casabona, Antonella Castagna, Dominique Costagliola, Francois Dabis, Stéphane de Wit, Gerd Fätkenheuer, Hansjakob Furrer, Anne Johnson, Mario Lazanas, Catherine Leport, Santiago Moreno, Niels Obel, Joanne Reekie, Peter Reiss, Caroline Sabin, Adriane Skaletz-Rorowski, Ignacio Suarez-Loano, Carlo Torti, Josiane Warszawski, Robert Zangerle, Céline Fabre-Colin, Jesper Kjaer, Genevieve Chene, Jesper Grarup, Ole Kirk, Antonella d'Arminio Monforte, Norbert Brockmeyer, Jordi Casabona, Antonella Castagna, Dominique Costagliola, Francois Dabis, Stéphane de Wit, Gerd Fätkenheuer, Hansjakob Furrer, Anne Johnson, Ole Kirk, Mario Lazanas, Catherine Leport, Jens Lundgren, Amanda Mocroft, Santiago Moreno, Niels Obel, Frank Post, Joanne Reekie, Peter Reiss, Caroline Sabin, Miriam Sabin, Adriane Skaletz-Rorowski, Ignacio Suarez-Loano, Carlo Torti, Josiane Warszawski, Robert Zangerle, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Frank de Wolf, Peter Reiss, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Osamah Hamouda, Barbara Bartmeyer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M. Miró, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, Ali Judd, Josiane Warszawski, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Maria Prins, Frank de Wolf, Jesper Grarup, Genevieve Chene, Céline Fabre-Colin, Christine Schwimmer, Monique Termote, Guillaume Touzeau, Maria Campbell, Jesper Kjaer, Nina Friis-Møller, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Frank de Wolf, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Rebecca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Viktor von Wyl, Linda Wittkop

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Abstract

Background:Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality.Methods and Findings:LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count 3or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95-0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19-20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55-12.43).Conclusions:LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.Please see later in the article for the Editors' Summary.

Original languageEnglish
Article numbere1001510
JournalPLoS Medicine
Volume10
Issue number9
DOIs
Publication statusPublished - 2013

ASJC Scopus subject areas

  • Medicine(all)

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    Mocroft, A., Lundgren, J. D., Sabin, M. L., d'Arminio Monforte, A., Brockmeyer, N., Casabona, J., Castagna, A., Costagliola, D., Dabis, F., De Wit, S., Fätkenheuer, G., Furrer, H., Johnson, A. M., Lazanas, M. K., Leport, C., Moreno, S., Obel, N., Post, F. A., Reekie, J., ... Wittkop, L. (2013). Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Medicine, 10(9), [e1001510]. https://doi.org/10.1371/journal.pmed.1001510