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Late presentation for HIV diagnosis and care in G ermany
Author(s) -
Zoufaly A,
Heiden M,
Marcus U,
Hoffmann C,
Stellbrink HJ,
Voss L,
Lunzen J,
Hamouda O
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2011.00958.x
Subject(s) - medicine , logistic regression , cohort , presentation (obstetrics) , human immunodeficiency virus (hiv) , psychological intervention , pediatrics , hiv diagnosis , descriptive statistics , family medicine , antiretroviral therapy , demography , viral load , surgery , mathematics , psychiatry , sociology , statistics
Objectives Antiretroviral therapy reduces mortality and morbidity in HIV ‐infected individuals most markedly when initiated early, before advanced immunodeficiency has developed. Late presentation for diagnosis and care remains a significant challenge. To guide public health interventions effectively it is crucial to describe the factors associated with late presentation. Methods Case surveillance data for all individuals newly diagnosed with HIV infection in G ermany in the years 2001–2010 and data for the years 1999–2010 from the G erman C linical S urveillance of HIV D isease ( ClinSurv ) cohort study, a large multicentre observational study, were analysed. Factors associated with late presentation ( CD 4 count < 350 cells/ μL or clinical AIDS ) were assessed using descriptive statistics and multivariable logistic regression methods. Results Among 22 925 eligible patients in the national surveillance database, 49.5% were late presenters for HIV diagnosis. Among 6897 treatment‐naïve patients in the ClinSurv cohort, 58.1% were late presenters for care. Late presenters for care were older (median 42 vs. 39 years for early presenters), more often heterosexuals from low‐prevalence countries (18.1% vs. 15.5%, respectively) and more often migrants (18.2% vs. 9.7%, respectively; all P < 0.005). The probability of late presentation was >65% throughout the observation period in migrants. The probability of late presentation for care clearly decreased in men who have sex with men ( MSM ) from 60% in 1999 to 45% in 2010. Conclusions In G ermany, the numbers of late presenters for HIV diagnosis and care remain high. The probability of late presentation for HIV diagnosis seems to be particularly high for migrants. These results argue in favour of targeted test promotion rather than opt‐out screening. Late presentation for care seems to be an additional problem after HIV diagnosis.