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
Por:
Sobrino-Vegas, P, Moreno, S, Rubio, R, Viciana, P, Bernardino, JI, Blanco, JR, Bernal, E, Asensi, V, Pulido, F, del Amo, J, Hernando, V, Domingo P., Sambeat, MA, Lamarca K., Mateo, G., Gutierrez, M., Espinosa, Nuria
Publicada:
1 may 2016
Resumen:
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 (aHR(LP.vs.nLP) = 10.3[CI95%: 5.5-19.3]); between 1 and 4 years post-diagnosis, aHR(LP.vs.nLP) = 1.9(1.2-3.0); and >4 years, aHR(LP.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. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of the The British Infection Association.
Filiaciones:
Sobrino-Vegas, P:
Inst Salud Carlos III, Ctr Nacl Epidemiol, Red Invest Sida, Avda Monforte de Lemos 5,Pabellon 11, Madrid 28029, Spain
CIBERESP, Madrid, Spain
Moreno, S:
Hosp Univ Ramon y Cajal, Madrid, Spain
Rubio, R:
Hosp Univ Doce Octubre, Madrid, Spain
Viciana, P:
Hosp Univ Virgen del Rocio, Seville, Spain
Bernardino, JI:
Hosp Univ La Paz, Madrid, Spain
Blanco, JR:
Hosp San Pedro, La Rioja, Spain
Bernal, E:
Hosp Gen Univ Reina Sofia, Murcia, Spain
Asensi, V:
Hosp Univ Cent Asturias, Oviedo, Spain
Pulido, F:
Hosp Univ Doce Octubre, Madrid, Spain
del Amo, J:
Inst Salud Carlos III, Ctr Nacl Epidemiol, Red Invest Sida, Avda Monforte de Lemos 5,Pabellon 11, Madrid 28029, Spain
CIBERESP, Madrid, Spain
Hernando, V:
Inst Salud Carlos III, Ctr Nacl Epidemiol, Red Invest Sida, Avda Monforte de Lemos 5,Pabellon 11, Madrid 28029, Spain
CIBERESP, Madrid, Spain
Domingo P.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Sambeat, MA:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Lamarca K.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Mateo, G.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Gutierrez, M.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Espinosa, Nuria :
Hosp Univ Virgen del Rocio, Seville, Spain
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