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Abstract

Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010–2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrolment) after 1 January 2010 with available CD4 count within six months of presentation were included. LP was defined as presentation with a CD4 count < 350/mm3 or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. A total of 30,454 people were included. The median CD4 count at presentation was 368/mm3 (interquartile range (IQR) 193–555/mm3), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02–1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85–0.94). Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.

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/content/10.2807/1560-7917.ES.2015.20.47.30070
2015-11-26
2017-10-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2015.20.47.30070
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References

  1. UNAIDS. Fast Track: Ending the AIDS epidemic by 2030. Geneva: UNAIDS 2015. Available from: http://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf
  2. Raymond A, Hill A, Pozniak A. Large disparities in HIV treatment cascades between eight European and high-income countries - analysis of break points. J Int AIDS Soc. 2014;17(4) Suppl 3;19507. PMID: 25394016 
  3. Chkhartishvili N, Sharavdze L, Chokoshvili O, DeHovitz JA, del Rio C, Tsertsvadze T. The cascade of care in the Eastern European country of Georgia. HIV Med. 2015;16(1):62-6.  https://doi.org/10.1111/hiv.12172  PMID: 24919923 
  4. European Centre for Disease Prevention and Control (ECDC). HIV/AIDS surveillance in Europe 2013. Stockholm: ECDC. 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/hiv-aids-surveillance-report-Europe-2013.pdf
  5. Working Group on Estimation of HIV Prevalence in Europe. HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV. AIDS. 2011;25(8):1017-23. PMID: 21422986 
  6. Girardi E, Aloisi MS, Arici C, Pezzotti P, Serraino D, Balzano R, et al. ICoNA Behavioural Epidemiology Study Group. Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy. J Acquir Immune Defic Syndr. 2004;36(4):951-9.  https://doi.org/10.1097/00126334-200408010-00009  PMID: 15220702 
  7. Mocroft A, Lundgren JD, Sabin ML, Monforte A, Brockmeyer N, Casabona J, et al. Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord. 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 Med. 2013;10(9):e1001510.  https://doi.org/10.1371/journal.pmed.1001510  PMID: 24137103 
  8. Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al. European Late Presenter Consensus Working Group. Late presentation of HIV infection: a consensus definition. HIV Med. 2011;12(1):61-4.  https://doi.org/10.1111/j.1468-1293.2010.00857.x  PMID: 20561080 
  9. Fleishman JA, Yehia BR, Moore RD, Gebo KAHIV Research Network. The economic burden of late entry into medical care for patients with HIV infection. Med Care. 2010;48(12):1071-9.  https://doi.org/10.1097/MLR.0b013e3181f81c4a  PMID: 21063228 
  10. Lanoy E, Mary-Krause M, Tattevin P, Perbost I, Poizot-Martin I, Dupont C, et al. ANRS C004 French Hospital Database on HIV Clinical Epidemiological Group. Frequency, determinants and consequences of delayed access to care for HIV infection in France. Antivir Ther. 2007;12(1):89-96. PMID: 17503752 
  11. Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al. Rakai Project Study Group. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med. 2000;342(13):921-9.  https://doi.org/10.1056/NEJM200003303421303  PMID: 10738050 
  12. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Sep 2015. Geneva: WHO. Available from: http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf
  13. Laut KG, Mocroft A, Lazarus J, Reiss P, Rockstroh J, Karpov I, et al. Eurosida in Eurocoord. Regional differences in self-reported HIV care and management in the EuroSIDA study. J Int AIDS Soc. 2014;17(4) Suppl 3;19504. PMID: 25394013 
  14. Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015;373(9):795-807.  https://doi.org/10.1056/NEJMoa1506816  PMID: 26192873 
  15. World Health Organization (WHO). Global update on HIV treatment 2013: Results, impact and opportunities. Jun 2013. Geneva: WHO. Available from: http://apps.who.int/iris/bitstream/10665/85326/1/9789241505734_eng.pdf?ua=1
  16. European Centre for Disease Prevention and Control (ECDC). HIV testing: increasing uptake and effectiveness in the European Union. Stockholm: ECDC. 2010. Available from: http://ecdc.europa.eu/en/publications/Publications/101129_GUI_HIV_testing.pdf
  17. Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS ONE. 2013;8(1):e52845.  https://doi.org/10.1371/journal.pone.0052845  PMID: 23341910 
  18. World Health Organization (WHO) Regional Office for Europe. Scaling up HIV testing and counseling in the WHO European Region - as an essential component of efforts to achieve universal access to HIV prevention, treatment, care and support. Policy framework. Copenhagen: WHO Europe. 2010. Available from: http://www.euro.who.int/__data/assets/pdf_file/0007/85489/E93715.pdf?ua=1
  19. Kjaer J, Ledergerber B. HIV cohort collaborations: proposal for harmonization of data exchange. Antivir Ther. 2004;9(4):631-3. PMID: 15456095 
  20. European Network of HIV/AIDS cohort studies to coordinate at European and International level clinical research on HIV/AIDS (EuroCoord). COHERE - Collaboration of Observational HIV Epidemiological Research in Europe. London: EuroCoord. [Accessed Nov 2015]. Available from: http://www.eurocoord.net/partners/founding_networks/cohere.aspx
  21. Centre for Health and Infectious Disease Research (CHIP). EuroSIDA. Copenhagen: CHIP. [Accessed 23 Nov 2015]. Available from: http://www.cphiv.dk/Ongoing-Studies/EuroSIDA/About
  22. Bannister WP, Kirk O, Gatell JM, Knysz B, Viard JP, Mens H, et al. EuroSIDA Study Group. Regional changes over time in initial virologic response rates to combination antiretroviral therapy across Europe. J Acquir Immune Defic Syndr. 2006;42(2):229-37.  https://doi.org/10.1097/01.qai.0000214815.95786.31  PMID: 16760800 
  23. Bannister WP, Ruiz L, Loveday C, Vella S, Zilmer K, Kjaer J, et al. EuroSIDA Study Group. HIV-1 subtypes and response to combination antiretroviral therapy in Europe. Antivir Ther. 2006;11(6):707-15. PMID: 17310815 
  24. Gökengin D, Geretti AM, Begovac J, Palfreeman A, Stevanovic M, Tarasenko O, et al. 2014 European Guideline on HIV testing. Int J STD AIDS. 2014;25(10):695-704.  https://doi.org/10.1177/0956462414531244  PMID: 24759563 
  25. World Health Organization (WHO). Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: WHO. 2007. Available from: http://apps.who.int/iris/bitstream/10665/43688/1/9789241595568_eng.pdf
  26. Degenhardt L, Mathers BM, Wirtz AL, Wolfe D, Kamarulzaman A, Carrieri MP, et al. What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010-2012? A review of the six highest burden countries. Int J Drug Policy. 2014;25(1):53-60.  https://doi.org/10.1016/j.drugpo.2013.08.004  PMID: 24113623 
  27. Kazatchkine M. Russia’s ban on methadone for drug users in Crimea will worsen the HIV/AIDS epidemic and risk public health. BMJ. 2014;348(may08 1):g3118.
  28. Deblonde J, Meulemans H, Callens S, Luchters S, Temmerman M, Hamers FF. HIV testing in Europe: mapping policies. Health Policy. 2011;103(2-3):101-10.  https://doi.org/10.1016/j.healthpol.2011.06.012  PMID: 21794943 
  29. Dray-Spira R, Lert F. Social health inequalities during the course of chronic HIV disease in the era of highly active antiretroviral therapy. AIDS. 2003;17(3):283-90.  https://doi.org/10.1097/00002030-200302140-00001  PMID: 12556681 
  30. Lodi S, Dray-Spira R, Touloumi G, Braun D, Teira R, D’Arminio Monforte A, et al. Socio-economic Inequalities and HIV Writing Group for Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord. Delayed HIV diagnosis and initiation of antiretroviral therapy: inequalities by educational level, COHERE in EuroCoord. AIDS. 2014;28(15):2297-306. PMID: 25313585 
  31. Health Protection Agency (HPA). HIV in the United Kingdom: 2010 report. HPR. 2010;4(47):2015.
  32. UK Collaborative HIV Cohort (CHIC) Study Steering Committee. HIV diagnosis at CD4 count above 500 cells/mm3 and progression to below 350 cells/mm3 without antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;46(3):275-8.  https://doi.org/10.1097/QAI.0b013e3181514441  PMID: 18172938 
  33. Haines CF, Fleishman JA, Yehia BR, Berry SA, Moore RD, Bamford LP, et al. HIV Research Network. Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era. J Acquir Immune Defic Syndr. 2014;67(1):84-90.  https://doi.org/10.1097/QAI.0000000000000228  PMID: 24872131 
  34. Lesko CR, Cole SR, Zinski A, Poole C, Mugavero MJ. A systematic review and meta-regression of temporal trends in adult CD4(+) cell count at presentation to HIV care, 1992-2011. Clin Infect Dis. 2013;57(7):1027-37.  https://doi.org/10.1093/cid/cit421  PMID: 23921882 
  35. Miranda AC, Moneti V, Brogueira P, Peres S, Baptista T, Aldir I, et al. Evolution trends over three decades of HIV infection late diagnosis: the experience of a Portuguese cohort of 705 HIV-infected patients. J Int AIDS Soc. 2014;17(4) Suppl 3;19688. PMID: 25397438 
  36. Jakopanec I, Grjibovski AM, Nilsen Ø, Blystad H, Aavitsland P. Trends in HIV infection surveillance data among men who have sex with men in Norway, 1995-2011. BMC Public Health. 2013;13(1):144.  https://doi.org/10.1186/1471-2458-13-144  PMID: 23414557 
  37. Delpierre C, Lauwers-Cances V, Pugliese P, Poizot-Martin I, Billaud E, Duvivier C, et al. NADIS Group. Characteristics trends, mortality and morbidity in persons newly diagnosed HIV positive during the last decade: the profile of new HIV diagnosed people. Eur J Public Health. 2008;18(3):345-7.  https://doi.org/10.1093/eurpub/ckm117  PMID: 18070812 
  38. Helleberg M, Engsig FN, Kronborg G, Laursen AL, Pedersen G, Larsen O, et al. Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort. Scand J Infect Dis. 2012;44(4):282-8.  https://doi.org/10.3109/00365548.2011.626440  PMID: 22066814 
  39. Pantaleo G, Graziosi C, Fauci AS. New concepts in the immunopathogenesis of human immunodeficiency virus infection. N Engl J Med. 1993;328(5):327-35.  https://doi.org/10.1056/NEJM199302043280508  PMID: 8093551 
  40. Sasse A, Florence E, Pharris A, De Wit S, Lacor P, Van Beckhoven D, et al. Belgian Research AIDS & HIV Consortium (BREACH). Late presentation to HIV testing is overestimated when based on the consensus definition. HIV Med. 2015;
  41. Mocroft A. Late presentation to HIV/AIDS testing, treatment or continued care: clarifying the use of CD4 evaluation in the consensus definition. HIV Med. 2014;15(3):129.  https://doi.org/10.1111/hiv.12101  PMID: 24495187 
  42. Likatavicius G, van de Laar MJ. HIV infection and AIDS in the European Union and European Economic Area, 2010. Euro Surveill. 2011;16(48):16(48):20030.
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