Frequency, determinants and consequences of delayed access to care for HIV infection in France

Abstract

Background and objectives: We analysed the frequency and predictors of delayed access to care (DAC) for HIV infection, and its influence on survival. Methods: We studied predictors of DAC among 18,721 patients enrolled between 1997 and 2002 in the French Hospital Database on HIV (FHDH), DAC being defined by a CD4+ T-cell count below 200 copies/mm3 and/or AIDS at FHDH enrolment. The association of DAC with the initiation of combined antiretroviral therapy (cART) and of DAC with survival were analysed with Cox multivariable models. Results: The overall prevalence of DAC was 35.7%. Compared with patients under 30 years of age, patients over 60 were 3.5 times more likely to have DAC (P<10-4). Compared with non-migrant women, odds ratios (OR) of DAC were higher among migrant women (1.5), non-migrant men (1.6) and migrant men (1.9; all P<10-4). Compared with men who have sex with men, other transmission groups had an estimated OR for DAC of 1.6 (P<10-4). DAC was more frequent among patients with a recent diagnosis of HIV infection [OR=1.3, 95% confidence intervals (CI)=(1.2;1.4)]. Patients with DAC received cART earlier than other patients [hazard ratio (HR)=2.2, 95% CI=(2.1;2.3)]. The DAC/mortality HR was 13.9 in the first 6 months after enrolment in the FHDH, and remained significantly higher than 1 during the subsequent 4 years. Conclusion: DAC is common in France and was associated with a higher mortality, despite early initiation of cART. Earlier access to care and specific clinical management of patients with DAC should be considered. © 2007 International Medical Press.