Retraso diagnóstico y enfermedad avanzada en la infección por el virus de la inmunodeficiencia humana en la Comunidad de Madrid (2007-2011)

Abstract

Background: Early HIV infection diagnosis means tremendous benefits both for the individual, in particular, and public heh, in general. The aim is to analyze the prevalence of delayed HIV-infection diagnosis in Madrid region and its related factors. Methods: Descriptive study of HIV-diagnosed patients from January 2007 to September 2011. A study was conducted on all new cases where the CD4+ count was below 200/µl ("presentation with advanced HIV disease", PAD), 350/µl ("late diagnosis", LD) and 500/µl. Descriptive and multivariate analysis by means of logistical regression. Results: 3,347 HIV-diagnoses were reported, with CD4 count data available in 2,896 cases. 29.7% of which were PAD, 48.1% were LD and 67.7%<500 CD4+. Both in Spaniards and foreigners, age and mode of transmission intravenous drug users (IDU) and heterosexual (HTX), were independent variables regarding late presentation. In foreigners, geographical origin was likewise an independent variable. In Spaniards the probability of contracting PAD and LD rise with age and was higher in HTX (OR:3.38 [95%CI:2.29-4.98) and 2.44 (1.67-3.56)] and IDU [OR: 2.41 (1.47-3.94) and 1.89 (1.19-3.01)] than men who have sex with men (MSM). For their part, probability of PAD and LD in foreigners increased with age and was higher in HTX (OR: 2.04 [1.44-2.89) and 2.29 (1.61-3.25)] than MSM and Latin American nationals (OR: 2.56 [1.48-4.42) and 2.29 (1.49-3.51)] and Sub-Saharan Africans (OR: 2.83 [1.52-5.28) and 2.52 (1.48-4.30)] than Western Europeans. Conclusions: In the Madrid Region a high number of new diagnoses are carried out in patients who should have already been under treatment. What is more some of them also present a significant degree of immuno-depression. Age, mode of transmission and geographical origin are closely related to late presentation.