Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort
Identifieur interne : 000325 ( Pmc/Curation ); précédent : 000324; suivant : 000326Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort
Auteurs : Eline L M. Op De Coul [Pays-Bas] ; Ard Van Sighem [Pays-Bas] ; Kees Brinkman [Pays-Bas] ; Birgit H. Van Benthem [Pays-Bas] ; Marchina E. Van Der Ende [Pays-Bas] ; Suzanne Geerlings [Pays-Bas] ; Peter Reiss [Pays-Bas]Source :
- BMJ Open [ 2044-6055 ] ; 2016.
Abstract
Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands.
HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined.
Of 20 965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥50 years (1.46; CI 1.33 to 1.60 vs 30–49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease.
Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.
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DOI: 10.1136/bmjopen-2015-009688
PubMed: 26729389
PubMed Central: 4716151
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Op De Coul</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM)</institution>,<addr-line>Bilthoven</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Sighem, Ard" sort="Van Sighem, Ard" uniqKey="Van Sighem A" first="Ard" last="Van Sighem">Ard Van Sighem</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brinkman, Kees" sort="Brinkman, Kees" uniqKey="Brinkman K" first="Kees" last="Brinkman">Kees Brinkman</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Internal Medicine</addr-line>,<institution>OLVG</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Benthem, Birgit H" sort="Van Benthem, Birgit H" uniqKey="Van Benthem B" first="Birgit H" last="Van Benthem">Birgit H. Van Benthem</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM)</institution>,<addr-line>Bilthoven</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Der Ende, Marchina E" sort="Van Der Ende, Marchina E" uniqKey="Van Der Ende M" first="Marchina E" last="Van Der Ende">Marchina E. 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Op De Coul</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM)</institution>,<addr-line>Bilthoven</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Sighem, Ard" sort="Van Sighem, Ard" uniqKey="Van Sighem A" first="Ard" last="Van Sighem">Ard Van Sighem</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brinkman, Kees" sort="Brinkman, Kees" uniqKey="Brinkman K" first="Kees" last="Brinkman">Kees Brinkman</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Internal Medicine</addr-line>,<institution>OLVG</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Benthem, Birgit H" sort="Van Benthem, Birgit H" uniqKey="Van Benthem B" first="Birgit H" last="Van Benthem">Birgit H. Van Benthem</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM)</institution>,<addr-line>Bilthoven</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Van Der Ende, Marchina E" sort="Van Der Ende, Marchina E" uniqKey="Van Der Ende M" first="Marchina E" last="Van Der Ende">Marchina E. Van Der Ende</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Department of Internal Medicine</addr-line>,<institution>Erasmus Medical Centre</institution>,<addr-line>Rotterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Geerlings, Suzanne" sort="Geerlings, Suzanne" uniqKey="Geerlings S" first="Suzanne" last="Geerlings">Suzanne Geerlings</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Department of Internal Medicine</addr-line>,<institution>Academic Medical Centre</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands.</p></sec><sec><title>Methods</title><p>HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined.</p></sec><sec><title>Results</title><p>Of 20 965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥50 years (1.46; CI 1.33 to 1.60 vs 30–49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease.</p></sec><sec><title>Conclusions</title><p>Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Van Aar, F" uniqKey="Van Aar F">F Van Aar</name></author><author><name sortKey="Koedijk, Fdh" uniqKey="Koedijk F">FDH Koedijk</name></author><author><name sortKey="Van Den Broek, Ivf" uniqKey="Van Den Broek I">IVF van den Broek</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Van Aar, F" uniqKey="Van Aar F">F van Aar</name></author><author><name sortKey="Van Weert, Y" uniqKey="Van Weert Y">Y van Weert</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id><journal-id journal-id-type="hwp">bmjopen</journal-id><journal-id journal-id-type="publisher-id">bmjopen</journal-id><journal-title-group><journal-title>BMJ Open</journal-title></journal-title-group><issn pub-type="epub">2044-6055</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26729389</article-id><article-id pub-id-type="pmc">4716151</article-id><article-id pub-id-type="publisher-id">bmjopen-2015-009688</article-id><article-id pub-id-type="doi">10.1136/bmjopen-2015-009688</article-id><article-categories><subj-group subj-group-type="heading"><subject>Epidemiology</subject><subj-group><subject>Research</subject></subj-group></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject><subject>1692</subject><subject>1842</subject></subj-group></article-categories><title-group><article-title>Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Op de Coul</surname><given-names>Eline L M</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>van Sighem</surname><given-names>Ard</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Brinkman</surname><given-names>Kees</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>van Benthem</surname><given-names>Birgit H</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib 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contrib-type="collab"><name><surname>de Jong</surname><given-names>A</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Broekhoven</surname><given-names>M</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Claessen</surname><given-names>E</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Rademaker</surname><given-names>MJ</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Munjishvili</surname><given-names>L</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Kruijne</surname><given-names>E</given-names></name></contrib><contrib contrib-type="collab"><name><surname>Tuk</surname><given-names>B</given-names></name></contrib></contrib-group><aff id="af1"><label>1</label><institution>Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM)</institution>,<addr-line>Bilthoven</addr-line>,<country>The Netherlands</country></aff><aff id="af2"><label>2</label><institution>Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></aff><aff id="af3"><label>3</label><addr-line>Department of Internal Medicine</addr-line>,<institution>OLVG</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></aff><aff id="af4"><label>4</label><addr-line>Department of Internal Medicine</addr-line>,<institution>Erasmus Medical Centre</institution>,<addr-line>Rotterdam</addr-line>,<country>The Netherlands</country></aff><aff id="af5"><label>5</label><addr-line>Department of Internal Medicine</addr-line>,<institution>Academic Medical Centre</institution>,<addr-line>Amsterdam</addr-line>,<country>The Netherlands</country></aff><author-notes><corresp><label>Correspondence to</label> Dr Eline LM Op de Coul; <email>eline.op.de.coul@rivm.nl</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>04</day><month>1</month><year>2016</year></pub-date><volume>6</volume><issue>1</issue><elocation-id>e009688</elocation-id><history><date date-type="received"><day>11</day><month>8</month><year>2015</year></date><date date-type="rev-recd"><day>28</day><month>9</month><year>2015</year></date><date date-type="accepted"><day>16</day><month>10</month><year>2015</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:href="bmjopen-2015-009688.pdf"></self-uri><abstract><sec><title>Objectives</title><p>Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands.</p></sec><sec><title>Methods</title><p>HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined.</p></sec><sec><title>Results</title><p>Of 20 965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥50 years (1.46; CI 1.33 to 1.60 vs 30–49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease.</p></sec><sec><title>Conclusions</title><p>Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.</p></sec></abstract><kwd-group><kwd>EPIDEMIOLOGY</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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