Late Presentation of HIV Most Common in Older Patients

Late presentation of advanced HIV is most common in patients of older age and those who have origins in sub-Sahara Africa, according to a study published in Infectious Disease Reports. Expanded screening strategies to target those outside of the most common risk factors should be taken into consideration when diagnosing HIV.

People living with HIV (PLWH) have a life expectancy that is about the same as the general population due to the introduction of antiretroviral therapy (ART). Assessing an area for those most at risk of contracting HIV is vital to addressing and responding to HIV to make sure patients get the best possible outcome. This study aimed to see how many people had late presentation (LP) of HIV, how many of those with LP had advanced HIV (LP-AD), and what those predictors are.

HIV Awareness | Image credit: Vasyl - stock.adobe.com

Patients 16 years and older who received care for the first time at the Liège University Hospital in Belgium between January 1, 2018, and July 31, 2022, were included in the study. Patients who had been diagnosed with HIV but had not been treated were also treated. Patients were excluded if they had already received care from another clinic or had been treated for more than 6 months. A patient’s CD4+ T-cell count at the initiation of ART was used to classify their presentation status. Patients were considered LPs if they had a CD4+ T-cell count of less than 350 cells/mm³ when they were first seen for care; advanced HIV was defined by having a CD4+ count of less than 200 cells/mm³.

Baseline characteristics for patients were collected, including their age, sex, ethnicity, and country of origin. The researchers also collected the reasons for screening, which included voluntary screening, pregnancy screening, and screening due to a partner having HIV, among other reasons.

There were 167 participants in this study, most of whom were men (70.7%); African was the most common ethnicity reported (45.5%). The patients had a median age of 37 (range, 18-79) years. A total of 20.4% of participants had a CD4+ T-cell count of less than 350 cells/mm³ and 21.6% had less than 200 cells/mm³. The transmission of HIV was about equally split between heterosexual partners (42.5%) and homo- or bisexual partners (41.3%), and screening most often happened when being treated for other medical issues (37.7%).

A total of 38.3% of patients were late presenters and 21.6% were late presenters with advanced HIV. Sex, ethnicity, origin, and mode of acquisition were found to be factors associated with LP; LP-AD was found to be associated with age, ethnicity, and origin. A multivariable model found that age and origin were associated with LP-AD. The risk of LP-AD increased with older age (OR, 7.48; 95% CI, 1.92-33.35) and sub-Saharan African origin, with those of Belgian origin having an odds ratio of 0.30 (95% CI, 0.11-0.75) when using those of sub-Saharan African origin as a reference.

This study had some limitations. All of the participants were getting care from Liège University Hospital, which could have limited the results. Risk factors for LP could have been missed in this study due to the chosen factors to focus on.

The researchers concluded that the diagnosis of HIV can be complex, especially in those who present late in the disease. Additional efforts to diagnose early should be taken to make sure all participants have the ability to be treated and to help in controlling the AIDS epidemic.

Reference

Scaia D, Fombellida K, Maes N, El Moussaoui M, Darcis G. Risk factors for late HIV presentation in patients treated at a single Belgian reference centre from 2018 to 2022. Infect Dis Rep. 2024;16:239-248. doi:10.3390/idr16020019