The study is the first extensive survey of late-onset HIV patients in Spain since the introduction of guidelines for early HIV diagnosis in 2014. Late-onset HIV was defined in the study as having a CD4 count < 350 at the time of diagnosis.
In Spain, people with late-onset AIDS present persistent and severe health problems, according to the findings published in PLoS One. Between January 1, 2004, and November 30, 2018, nearly 45% of patients enrolled in the study had a late onset.
The study surveyed late-onset HIV patients at three different time periods: 2004-2008, 2009-2012 and 2013-2018, after the Spanish Ministry of Health introduced guidelines on early HIV diagnosis in 2014.
In particular, the study investigated prevalence, risk factors, and the impact of risk factors on clinical outcomes, as well as patients’ first aiDS-induced illness, first severe non-AIDS illness, or overall all-cause death.
According to cohort data from the Spanish Network for AIDS Research (CoRIS), before the guidelines were introduced, there was a notification rate of 46.9% of late-onset HIV patients.
Patients with late-onset HIV were defined as having a CD4 count < 350 at the time of diagnosis or an AIDS-induced illness between 4 and 24 weeks after study enrollment.
The overall rate of delayed HIV infection was 44.6% (95%CI, 43.8%-45.4%). The main risk factors independently associated with delayed HIV infection were:
① Older age: 77% of people aged 50 and above, 36% of people aged 30 to 49
② Infection through injecting drug use: 49%
③ Heterosexual intercourse (male) : 41%
(4) Heterosexual intercourse (female) : 27%
⑤ Low level of education: primary education 31%, secondary education 9%
⑥ Non-European countries: 17% in sub-Saharan Africa and 23% in Latin America
In the study, CoRIS provided data on 14,876 people — all adults over the age of 18 who were starting antiviral therapy for the first time. Most participants were male (85.0%), gay (61.7%), and European (72.6%). The median age was 35.2 years and the median CD4 count was 397. In patients diagnosed with AIDS, they have a viral load of at least 100,000 copies per milliliter.
“The reason that [late] prevalence has stopped declining may be related to the continuing low frequency of HIV testing in Spain,” the study authors wrote. “This low frequency may be due to lack of awareness of HIV infection, stigma, lack of knowledge about health services, and lack of testing availability.”
The researchers also identified educational level, immigration status and low self-perceived risk capacity as factors affecting the late onset rate.
“Screening and early diagnosis of HIV should be expanded, with a focus on those groups most at risk of late onset.” “For example, targeted diagnostic programs can be implemented in emergency departments, primary care, and other health centers; HIV testing can be made a priority in primary care and access to information for health care providers can be initiated to improve the application of clinical standards.”