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Background and objectives   We analysed the frequency and predictors of delayed access to care (DAC) for HIV infection, and its influence on survival.Methods   We studied predictors of DAC among 18,721 patients enrolled between 1997 and 2002 in the French Hospital Database on HIV (FHDH), DAC being defined by a CD4 +  T-cell count below 200 copies/mm 3  and/or AIDS at FHDH enrolment. The association of DAC with the initiation of combined antiretroviral therapy (cART) and of DAC with survival were analysed with Cox multivariable models.Results   The overall prevalence of DAC was 35.7%. Compared with patients under 30 years of age, patients over 60 were 3.5 times more likely to have DAC (P&lt;10 -4 ). Compared with non-migrant women, odds ratios (OR) of DAC were higher among migrant women (1.5), non-migrant men (1.6) and migrant men (1.9; all P&lt;10 -4 ). Compared with men who have sex with men, other transmission groups had an estimated OR for DAC of 1.6 (P&lt;10 -4 ). DAC was more frequent among patients with a recent diagnosis of HIV infection [OR=1.3, 95% confidence intervals (CI)=(1.2;1.4)]. Patients with DAC received cART earlier than other patients [hazard ratio (HR)=2.2, 95% CI=(2.1;2.3)]. The DAC/mortality HR was 13.9 in the first 6 months after enrolment in the FHDH, and remained significantly higher than 1 during the subsequent 4 years.Conclusion   DAC is common in France and was associated with a higher mortality, despite early initiation of cART. Earlier access to care and specific clinical management of patients with DAC should be considered.

Frequency, determinants and consequences of delayed access to care for HIV infection in France