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J Infect. 2016 May;72(5):587-96. doi: 10.1016/j.jinf.2016.01.017. Epub 2016 Feb 24.

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.

Collaborators (253)

Moreno S, del Amo J, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Gonzalez-Garcia J, Berenguer J, Sobrino P, Hernando V, Alejos B, Álvarez D, Monge S, Jarrín I, Rivero Y, González C, Muñoz-Fernández MÁ, García-Merino I, Rico CG, de la Fuente JG, Torre AG, Portilla J, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Podzamczer D, Imaz EF, Van Den Eyncle E, Di Yacovo S, Sumoy M, Gómez JL, Rodríguez P, Alemán MR, Alonso Mdel M, Hernández MI, Díaz-Flores F, García D, Pelazas R, Soriano V, Labarga P, Barreiro P, Rivas P, Blanco F, Carbonero LM, Vispo E, Solera C, Asensi V, Valle E, Cartón JA, Pérez VE, Molina MJ, García JV, Carrera EP, Rubio R, Pulido F, Bisbal O, Matarranz M, Lagarde M, Maestro G, Rubio-Martín R, Hernando A, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Galparsoro HA, Ibarguren M, Aguado M, Gutiérrez F, Masiá M, López C, Padilla S, Navarro A, Montolio F, Robledano C, Colomé JG, Adsuar A, Pascual R, Carlos F, Martinez M, Muga R, Tor J, Sanvisens A, Berenguer J, de Quirós JC, Miralles P, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Carrero A, Aldamiz-Echevarría T, Tejerina F, Parras FJ, Balsalobre P, Diez C, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Aguilar A, Sirvent JJ, Alba V, Calavia O, Montero M, Lacruz J, Blanes M, Calabuig E, Cuellar S, López J, Salavert M, González J, de la Serna IB, Arribas JR, Montes ML, Peña JM, Arribas B, Castro JM, Zamora FJ, Pérez I, Estébanez M, García S, Díaz M, Alcáriz NS, Mingorance J, Montero D, González A, de José MI, de los Santos I, Sanz J, Salas A, Sarriá C, Gómez A, Oteo JA, Blanco JR, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Pascual A, Ramos C, Arazo P, Gil D, Dalmau D, Jaén A, Cairó M, Irigoyen D, Jordano Q, Xercavins M, Martinez-Lacasa J, Velli P, Font R, Sanmartí M, Ibáñez L, Rivero M, Casado MI, Díaz JA, Uriz J, Repáraz J, Irigoyen C, Arraiza MJ, Segura F, Amengual MJ, Navarro G, Sala M, Cervantes M, Pineda V, Segura V, Navarro M, Antón E, Nogueras MM, Moreno S, Casado JL, Dronda F, Moreno A, Elías MJ, López D, Gutiérrez C, Hernández B, Madrid N, Lamas A, Martí P, de Diaz A, Serrano S, Donat L, Cano A, Bernal E, Muñoz Á, García F, Hernández J, Peña A, Muñoz L, Parra J, Alvarez M, Chueca N, Guillot V, Vinuesa D, Fernández JA, Del Romero J, Rodríguez C, Puerta T, Carrió JC, González C, Vera M, Ballesteros J, Domingo P, Sambeat MA, Lamarca K, Mateo G, Gutiérrez M, Fernández I, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Gil L, Fanjul F, Marinescu C, Ribera E, Santos J, Márquez M, Viciana I, Palacios R, Pérez I, González CM, Viciana P, Leal M, López-Cortés LF, Trastoy M, Espinosa N.

Author information

1
Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address: psobrino@isciii.es.
2
Hospital Universitario Ramón y Cajal, Madrid, Spain.
3
Hospital Universitario Doce de Octubre, Madrid, Spain.
4
Hospital Universitario Virgen del Rocío, Sevilla, Spain.
5
Hospital Universitario La Paz, Madrid, Spain.
6
Hospital San Pedro, La Rioja, Spain.
7
Hospital General Universitario Reina Sofía, Murcia, Spain.
8
Hospital Universitario Central de Asturias, Oviedo, Spain.
9
Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.

Abstract

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.

KEYWORDS:

Causes of death; Cohort study; Factors and trends; HIV; Late presentation; Mortality

PMID:
26920789
DOI:
10.1016/j.jinf.2016.01.017
[Indexed for MEDLINE]
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