The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999-2013

M Taborelli, S Virdone, L Camoni, V Regine, A Zucchetto, L Frova, E Grande, S Boros, L Dal Maso, P De Paoli, D Serraino, B Suligoi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy.

STUDY DESIGN: We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013.

METHODS: Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time.

RESULTS: Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5).

CONCLUSIONS: The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.

Original languageEnglish
Pages (from-to)39-45
Number of pages7
JournalPublic Health
Volume142
DOIs
Publication statusPublished - Jan 2017

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Italy
Acquired Immunodeficiency Syndrome
HIV
Confidence Intervals
Population
Odds Ratio
Heterosexuality
Virus Diseases
Drug Users
Infection
Registries
Therapeutics
Age Groups
Education

Keywords

  • Acquired Immunodeficiency Syndrome/drug therapy
  • Adolescent
  • Adult
  • Delayed Diagnosis/statistics & numerical data
  • Female
  • HIV Infections/diagnosis
  • Humans
  • Italy/epidemiology
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Young Adult

Cite this

The persistent problem of late HIV diagnosis in people with AIDS : a population-based study in Italy, 1999-2013. / Taborelli, M; Virdone, S; Camoni, L; Regine, V; Zucchetto, A; Frova, L; Grande, E; Boros, S; Dal Maso, L; De Paoli, P; Serraino, D; Suligoi, B.

In: Public Health, Vol. 142, 01.2017, p. 39-45.

Research output: Contribution to journalArticle

Taborelli, M, Virdone, S, Camoni, L, Regine, V, Zucchetto, A, Frova, L, Grande, E, Boros, S, Dal Maso, L, De Paoli, P, Serraino, D & Suligoi, B 2017, 'The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999-2013', Public Health, vol. 142, pp. 39-45. https://doi.org/10.1016/j.puhe.2016.10.009
Taborelli, M ; Virdone, S ; Camoni, L ; Regine, V ; Zucchetto, A ; Frova, L ; Grande, E ; Boros, S ; Dal Maso, L ; De Paoli, P ; Serraino, D ; Suligoi, B. / The persistent problem of late HIV diagnosis in people with AIDS : a population-based study in Italy, 1999-2013. In: Public Health. 2017 ; Vol. 142. pp. 39-45.
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abstract = "OBJECTIVES: Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy.STUDY DESIGN: We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013.METHODS: Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95{\%} confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time.RESULTS: Among 20,753 adult PWA, 50.8{\%} were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5{\%} vs 68.2{\%}). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95{\%} CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95{\%} CI: 1.12-1.37 and OR = 1.51, 95{\%} CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95{\%} CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95{\%} CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95{\%} CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95{\%} CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95{\%} CI: 5.7-17.5).CONCLUSIONS: The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.",
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author = "M Taborelli and S Virdone and L Camoni and V Regine and A Zucchetto and L Frova and E Grande and S Boros and {Dal Maso}, L and {De Paoli}, P and D Serraino and B Suligoi",
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year = "2017",
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doi = "10.1016/j.puhe.2016.10.009",
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TY - JOUR

T1 - The persistent problem of late HIV diagnosis in people with AIDS

T2 - a population-based study in Italy, 1999-2013

AU - Taborelli, M

AU - Virdone, S

AU - Camoni, L

AU - Regine, V

AU - Zucchetto, A

AU - Frova, L

AU - Grande, E

AU - Boros, S

AU - Dal Maso, L

AU - De Paoli, P

AU - Serraino, D

AU - Suligoi, B

N1 - Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

PY - 2017/1

Y1 - 2017/1

N2 - OBJECTIVES: Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy.STUDY DESIGN: We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013.METHODS: Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time.RESULTS: Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5).CONCLUSIONS: The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.

AB - OBJECTIVES: Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy.STUDY DESIGN: We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013.METHODS: Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time.RESULTS: Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5).CONCLUSIONS: The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.

KW - Acquired Immunodeficiency Syndrome/drug therapy

KW - Adolescent

KW - Adult

KW - Delayed Diagnosis/statistics & numerical data

KW - Female

KW - HIV Infections/diagnosis

KW - Humans

KW - Italy/epidemiology

KW - Male

KW - Middle Aged

KW - Registries

KW - Risk Factors

KW - Young Adult

U2 - 10.1016/j.puhe.2016.10.009

DO - 10.1016/j.puhe.2016.10.009

M3 - Article

C2 - 28057195

VL - 142

SP - 39

EP - 45

JO - Public Health

JF - Public Health

SN - 0033-3506

ER -