Determinants of HIV-1 late presentation in a cohort of Portuguese HIV-1 patients

Background: Undiagnosed HIV-1 patients still account for 25% of worldwide HIV patients. Studying late presenters for HIV care may help to identify characteristics of such patients. Objective: The present study aims to identify factors associated with late presentation (LP) and late presentation with advanced disease (LPAD) based on a population of patients followed in a Portuguese hospital between 1984 and 2017. Methods: Sociodemographic and clinical data from infected patients with HIV-1 aged 18 years and older, followed in Egas Moniz Hospital, in Portugal were collected. Results: Of the 907 patients included in this study, 68.7% were males and the median age was 37 years (IQR 30-47). 459 patients (50.6%) were LP and, of these, 284 patients (61.9%) were LPAD. The LP population mostly originated from Portugal and Sub-Saharan Africa (64.4% and 28.8%; p=0.004) and the HIV exposure category mainly heterosexuals and MSM (57.0% and 24.9%; p<0.001). The stage of disease and viral load at diagnosis were significantly associated with both LP and LPAD (p<0.001). Factors associated with LP in the logistic regression included age at diagnosis lower than 30y (aOR 0.34; 0.17-0.68; p=0.002) and origin from Sub-Saharan Africa (aOR 2.24; 1.44-3.50; p<0.001). Conclusion: Late presentation is a major obstacle to halt the HIV epidemic. In this population, the majority of newly diagnosed HIV-infected individuals were late presenters. Our results characterize vulnerable populations that should be frequently tested for HIV. Keywords: HIV-1 infection, Late presentation, Late presentation with advanced disease