Late Presentation for HIV Care Across Europe: Update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study, 2010 to 2013

Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010–2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrolment) after 1 January 2010 with available CD4 count within six months of presentation were included. 

LP was defined as presentation with a CD4 count < 350/mm³ or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. 

A total of 30,454 people were included. The median CD4 count at presentation was 368/mm³ (interquartile range (IQR) 193–555/mm³), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). 

There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02–1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85–0.94). 

Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.

Below:  Adjusted odds of having no CD4 count information within six months following HIV diagnosis, COHERE study, 2010–2013

Characteristics of included patients, COHERE study, 2010–2013 (n=30,454)

Patients’ characteristics		All		Late presenters
		N	Percentage (%)a	N	Percentage of late presenters (%)b
All		30,454	100	14,586	47.9
Delayed entry to carec	No	26,751	95.5	12,818	47.9
	Yes	1,247	4.5	494	39.6
HIV exposure group	MSM	15,371	50.5	5,993	39.0
	Heterosexual men	4,826	15.8	3,011	62.4
	Heterosexual females	5,487	18.0	2,864	52.2
	PWID (male)	843	2.8	481	57.1
	PWID (female)	321	1.1	126	39.3
	Male other	2,551	8.8	1,495	58.6
	Female other	1,055	3.5	616	58.4
Region of care in Europe	Southern	11,692	38.4	5,704	48.8
	Central	9,625	31.6	4,791	49.8
	Northern	7,760	25.5	3,550	45.8
	Eastern	1,377	4.5	541	38.3
Continent of origin	Europe	20,701	68.0	9,495	45.9
	Africa	2,651	8.7	1,696	64.0
	Other	2,685	8.8	1,428	53.2
	Unknown	4,417	14.5	1,967	44.5
		Median	IQR	Median	IQR
Age	Years	36	29–45	39	31–48
CD4	/mm3	368	193–555	184	73–276
Baselined	Month/year	6/2011	9/2010–4/2012	6/2011	9/2010–4/2012

COHERE: Collaboration of Observational HIV Epidemiological Research Europe; IQR: interquartile range; MSM: men who have sex with men; PWID: people who inject drugs.

a% represents percentage of total; for example, 15,371/30,454 (50.5%) of the population included were MSM.

b % represents the percentage of late presenters; for example, 5,993/15,371 (39.0%) of MSM were late presenters.

c Delayed entry into care was defined as more than three months between HIV diagnosis and first visit to clinic, in people with both dates recorded (n = 27,998).

d Baseline was defined as the earliest of HIV test, first study visit or cohort enrolment.

Late presentation: diagnosed with HIV with a CD4 count below 350/mm3 or an AIDS defining event regardless of the CD4 count, in the six months following HIV-diagnosis [8].

Below:  Changes over time in stages of late presentation and CD4 count at HIV diagnosis, COHERE study, 2010–2013 (N=30,454)

Below:  Changes over time in late presentation by HIV exposure groups, COHERE study, 2010–2013 (n=30,454)

Below:  Changes over time in late presentation by region of care in Europe, COHERE study, 2010–2013 (N=30,454)

Full article at:   http://goo.gl/tLt6LP

By:  Analysis and Writing Committee: Amanda Mocroft, Jens Lundgren, Andrea Antinori, Antonella d’Arminio Monforte, Johanna Brännström, Fabrice Bonnet, Norbert Brockmeyer, Jordi Casabona, Antonella Castagna, Dominique Costagliola, Stéphane De Wit, Gerd Fätkenheuer, Hansjakob Furrer, Corinne Jadand, Anne Johnson, Mario Lazanas, Catherine Leport, Santiago Moreno, Christina Mussini, Niels Obel, Frank Post, Peter Reiss, Caroline Sabin, Adriane Skaletz-Rorowski, Ignacio Suarez-Loano, Carlo Torti, Josiane Warszawski, Linda Wittkop, Robert Zangerle, Genevieve Chene, Dorthe Raben, Ole Kirk.

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