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
Paz Sobrino-Vegas, Santiago Moreno, Rafael Rubio, Pompeyo Viciana, José Ignacio Bernardino, José Ramón Blanco, Enrique Bernal, Víctor Asensi, Federico Pulido, Julia del Amo, Victoria Hernando, Cohorte de la Red de Investigación en Sida, Spain, Santiago Moreno, Julia del Amo, David Dalmau, Maria Luisa Navarro, Maria Isabel González, Jose Luis Blanco, Federico Garcia, Rafael Rubio, Jose Antonio Iribarren, Félix Gutiérrez, Francesc Vidal, Juan Gonzalez-Garcia, Juan Berenguer, Paz Sobrino, Victoria Hernando, Belén Alejos, Débora Álvarez, Susana Monge, Inma Jarrín, Yaiza Rivero, Cristina González, M Ángeles Muñoz-Fernández, Isabel García-Merino, Coral Gómez Rico, Jorge Gallego de la Fuente, Almudena García Torre, Joaquín Portilla, Sergio Reus, Vicente Boix, Livia Giner, Carmen Gadea, Irene Portilla, Maria Pampliega, Marcos Díez, Juan Carlos Rodríguez, Jose Sánchez-Payá, Daniel Podzamczer, Elena Ferrerm Arkaitz Imaz, Evan Van Den Eyncle, Silvana Di Yacovo, Maria Sumoy, Juan Luis Gómez, Patricia Rodríguez, María Remedios Alemán, María del Mar Alonso, María Inmaculada Hernández, Felicitas Díaz-Flores, Dácil García, Ricardo Pelazas, Vicente Soriano, Pablo Labarga, Pablo Barreiro, Pablo Rivas, Francisco Blanco, Luz Martín Carbonero, Eugenia Vispo, Carmen Solera, Victor Asensi, Eulalia Valle, José Antonio Cartón, Vicente Estrada Pérez, Maria Jesus Téllez Molina, Jorge Vergas García, Elisa Pérez-Cecila Carrera, Rafael Rubio, Federico Pulido, Otilia Bisbal, Mariano Matarranz, Maria Lagarde, Guillermo Maestro, Rafael Rubio-Martín, Asunción Hernando, José Antonio Iribarren, Julio Arrizabalaga, María José Aramburu, Xabier Camino, Francisco Rodríguez-Arrondo, Miguel Ángel von Wichmann, Lidia Pascual Tomé, Miguel Ángel Goenaga, Ma Jesús Bustinduy, Harkaitz Azkune Galparsoro, Maialen Ibarguren, Mirian Aguado, Félix Gutiérrez, Mar Masiá, Cristina López, Sergio Padilla, Andrés Navarro, Fernando Montolio, Catalina Robledano, Joan Gregori Colomé, Araceli Adsuar, Rafael Pascual, Federico Carlos, Maravillas Martinez, Roberto Muga, Jordi Tor, Arantza Sanvisens, Juan Berenguer, Juan Carlos López Bernaldo de Quirós, Pilar Miralles, Isabel Gutiérrez, Margarita Ramírez, Belén Padilla, Paloma Gijón, Ana Carrero, Teresa Aldamiz-Echevarría, Francisco Tejerina, Francisco Jose Parras, Pascual Balsalobre, Cristina Diez, Francesc Vidal, Joaquín Peraire, Consuelo Viladés, Sergio Veloso, Montserrat Vargas, Miguel López-Dupla, Montserrat Olona, Alba Aguilar, Joan Josep Sirvent, Verónica Alba, Olga Calavia, Marta Montero, José Lacruz, Marino Blanes, Eva Calabuig, Sandra Cuellar, José López, Miguel Salavert, Juan González, Ignacio Bernardino de la Serna, José Ramón Arribas, María Luisa Montes, Jose Ma Peña, Blanca Arribas, Juan Miguel Castro, Fco Javier Zamora, Ignacio Pérez, Miriam Estébanez, Silvia García, Marta Díaz, Natalia Stella Alcáriz, Jesús Mingorance, Dolores Montero, Alicia González, Maria Isabel de José, Ignacio de los Santos, Jesús Sanz, Ana Salas, Cristina Sarriá, Ana Gómez, José Antonio Oteo, José Ramón Blanco, Valvanera Ibarra, Luis Metola, Mercedes Sanz, Laura Pérez-Martínez, Ascensión Pascual, Carlos Ramos, Piedad Arazo, Desiré Gil, David Dalmau, Angels Jaén, Mireia Cairó, Daniel Irigoyen, Queralt Jordano, Mariona Xercavins, Javier Martinez-Lacasa, Pablo Velli, Roser Font, Montse Sanmartí, Laura Ibáñez, María Rivero, Marina Itziar Casado, Jorge Alberto Díaz, Javier Uriz, Jesús Repáraz, Carmen Irigoyen, María Jesús Arraiza, Ferrán Segura, María José Amengual, Gemma Navarro, Montserrat Sala, Manuel Cervantes, Valentín Pineda, Victor Segura, Marta Navarro, Esperanza Antón, Ma Merce Nogueras, Santiago Moreno, José Luis Casado, Fernando Dronda, Ana Moreno, María Jesús Pérez Elías, Dolores López, Carolina Gutiérrez, Beatriz Hernández, Nadia Madrid, Angel Lamas, Paloma Martí, Alberto de Diaz, Sergio Serrano, Lucas Donat, Alfredo Cano, Enrique Bernal, Ángeles Muñoz, Federico García, José Hernández, Alejandro Peña, Leopoldo Muñoz, Jorge Parra, Marta Alvarez, Natalia Chueca, Vicente Guillot, David Vinuesa, Jose Angel Fernández, Jorge Del Romero, Carmen Rodríguez, Teresa Puerta, Juan Carlos Carrió, Cristina González, Mar Vera, Juan Ballesteros, Pere Domingo, Ma Antonia Sambeat, Karuna Lamarca, Gracia Mateo, Mar Gutiérrez, Irene Fernández, Antonio Antela, Elena Losada, Melchor Riera, Maria Peñaranda, Maria Leyes, Ma Angels Ribas, Antoni A Campins, Carmen Vidal, Leire Gil, Francisco Fanjul, Carmen Marinescu, Esteban Ribera, Jesús Santos, Manuel Márquez, Isabel Viciana, Rosario Palacios, Isabel Pérez, Carmen Maria González, Pompeyo Viciana, Manuel Leal, Luis Fernando López-Cortés, Mónica Trastoy, Nuria Espinosa, Paz Sobrino-Vegas, Santiago Moreno, Rafael Rubio, Pompeyo Viciana, José Ignacio Bernardino, José Ramón Blanco, Enrique Bernal, Víctor Asensi, Federico Pulido, Julia del Amo, Victoria Hernando, Cohorte de la Red de Investigación en Sida, Spain, Santiago Moreno, Julia del Amo, David Dalmau, Maria Luisa Navarro, Maria Isabel González, Jose Luis Blanco, Federico Garcia, Rafael Rubio, Jose Antonio Iribarren, Félix Gutiérrez, Francesc Vidal, Juan Gonzalez-Garcia, Juan Berenguer, Paz Sobrino, Victoria Hernando, Belén Alejos, Débora Álvarez, Susana Monge, Inma Jarrín, Yaiza Rivero, Cristina González, M Ángeles Muñoz-Fernández, Isabel García-Merino, Coral Gómez Rico, Jorge Gallego de la Fuente, Almudena García Torre, Joaquín Portilla, Sergio Reus, Vicente Boix, Livia Giner, Carmen Gadea, Irene Portilla, Maria Pampliega, Marcos Díez, Juan Carlos Rodríguez, Jose Sánchez-Payá, Daniel Podzamczer, Elena Ferrerm Arkaitz Imaz, Evan Van Den Eyncle, Silvana Di Yacovo, Maria Sumoy, Juan Luis Gómez, Patricia Rodríguez, María Remedios Alemán, María del Mar Alonso, María Inmaculada Hernández, Felicitas Díaz-Flores, Dácil García, Ricardo Pelazas, Vicente Soriano, Pablo Labarga, Pablo Barreiro, Pablo Rivas, Francisco Blanco, Luz Martín Carbonero, Eugenia Vispo, Carmen Solera, Victor Asensi, Eulalia Valle, José Antonio Cartón, Vicente Estrada Pérez, Maria Jesus Téllez Molina, Jorge Vergas García, Elisa Pérez-Cecila Carrera, Rafael Rubio, Federico Pulido, Otilia Bisbal, Mariano Matarranz, Maria Lagarde, Guillermo Maestro, Rafael Rubio-Martín, Asunción Hernando, José Antonio Iribarren, Julio Arrizabalaga, María José Aramburu, Xabier Camino, Francisco Rodríguez-Arrondo, Miguel Ángel von Wichmann, Lidia Pascual Tomé, Miguel Ángel Goenaga, Ma Jesús Bustinduy, Harkaitz Azkune Galparsoro, Maialen Ibarguren, Mirian Aguado, Félix Gutiérrez, Mar Masiá, Cristina López, Sergio Padilla, Andrés Navarro, Fernando Montolio, Catalina Robledano, Joan Gregori Colomé, Araceli Adsuar, Rafael Pascual, Federico Carlos, Maravillas Martinez, Roberto Muga, Jordi Tor, Arantza Sanvisens, Juan Berenguer, Juan Carlos López Bernaldo de Quirós, Pilar Miralles, Isabel Gutiérrez, Margarita Ramírez, Belén Padilla, Paloma Gijón, Ana Carrero, Teresa Aldamiz-Echevarría, Francisco Tejerina, Francisco Jose Parras, Pascual Balsalobre, Cristina Diez, Francesc Vidal, Joaquín Peraire, Consuelo Viladés, Sergio Veloso, Montserrat Vargas, Miguel López-Dupla, Montserrat Olona, Alba Aguilar, Joan Josep Sirvent, Verónica Alba, Olga Calavia, Marta Montero, José Lacruz, Marino Blanes, Eva Calabuig, Sandra Cuellar, José López, Miguel Salavert, Juan González, Ignacio Bernardino de la Serna, José Ramón Arribas, María Luisa Montes, Jose Ma Peña, Blanca Arribas, Juan Miguel Castro, Fco Javier Zamora, Ignacio Pérez, Miriam Estébanez, Silvia García, Marta Díaz, Natalia Stella Alcáriz, Jesús Mingorance, Dolores Montero, Alicia González, Maria Isabel de José, Ignacio de los Santos, Jesús Sanz, Ana Salas, Cristina Sarriá, Ana Gómez, José Antonio Oteo, José Ramón Blanco, Valvanera Ibarra, Luis Metola, Mercedes Sanz, Laura Pérez-Martínez, Ascensión Pascual, Carlos Ramos, Piedad Arazo, Desiré Gil, David Dalmau, Angels Jaén, Mireia Cairó, Daniel Irigoyen, Queralt Jordano, Mariona Xercavins, Javier Martinez-Lacasa, Pablo Velli, Roser Font, Montse Sanmartí, Laura Ibáñez, María Rivero, Marina Itziar Casado, Jorge Alberto Díaz, Javier Uriz, Jesús Repáraz, Carmen Irigoyen, María Jesús Arraiza, Ferrán Segura, María José Amengual, Gemma Navarro, Montserrat Sala, Manuel Cervantes, Valentín Pineda, Victor Segura, Marta Navarro, Esperanza Antón, Ma Merce Nogueras, Santiago Moreno, José Luis Casado, Fernando Dronda, Ana Moreno, María Jesús Pérez Elías, Dolores López, Carolina Gutiérrez, Beatriz Hernández, Nadia Madrid, Angel Lamas, Paloma Martí, Alberto de Diaz, Sergio Serrano, Lucas Donat, Alfredo Cano, Enrique Bernal, Ángeles Muñoz, Federico García, José Hernández, Alejandro Peña, Leopoldo Muñoz, Jorge Parra, Marta Alvarez, Natalia Chueca, Vicente Guillot, David Vinuesa, Jose Angel Fernández, Jorge Del Romero, Carmen Rodríguez, Teresa Puerta, Juan Carlos Carrió, Cristina González, Mar Vera, Juan Ballesteros, Pere Domingo, Ma Antonia Sambeat, Karuna Lamarca, Gracia Mateo, Mar Gutiérrez, Irene Fernández, Antonio Antela, Elena Losada, Melchor Riera, Maria Peñaranda, Maria Leyes, Ma Angels Ribas, Antoni A Campins, Carmen Vidal, Leire Gil, Francisco Fanjul, Carmen Marinescu, Esteban Ribera, Jesús Santos, Manuel Márquez, Isabel Viciana, Rosario Palacios, Isabel Pérez, Carmen Maria González, Pompeyo Viciana, Manuel Leal, Luis Fernando López-Cortés, Mónica Trastoy, Nuria Espinosa
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.
Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed