Background: Limited data are available on long-term outcomes in recent years for late HIV diagnosis (LD). Methods: All HIV-positive subjects enrolled in Icona Cohort in 2009-2022 starting ART within 4-months from diagnosis were included and divided into:1) pre-ART CD4 count≥350/mm3 without AIDS (non-LD), 2) pre-ART CD4 count<350/mm3 without AIDS (LD-Asymptomatic), 3) with AIDS events pre-ART (LD-AIDS). Estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure (TF) were evaluated. Results: 6,813 participants: 2,448 non-LD, 3,198 LD-Asymptomatic, and 1,167 LD-AIDS, 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD compared to non-LD (p<0.001), and within the former, for LD-AIDS over LD-Asymptomatic (p<0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD aHR=5.51, p<0.001), and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR=4.42, p<0.001), AIDS-related (aSHR=16.86, p<0.001) and not AIDS-related mortality (aSHR=1.74, p=0.022) compared to the rest of the late presenters. Among short-term survivors LD-AIDS, the long-term mortality was mediated by the lack of immune-recovery at 2-years. LD compared to non-LD, and particularly among the former, LD-AIDS over LD-Asymptomatic, showed also a greater risk of TF. Conclusions: In recent years, LD subjects, particularly AIDS-presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.

Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late for HIV diagnosis – results from the Icona cohort in Italy, 2009-2022 / Mondi, Annalisa; Cozzi-Lepri, Alessandro; Tavelli, Alessandro; Cingolani, Antonella; Giacomelli, Andrea; Orofino, Giancarlo; De Girolamo, Gabriella; Pinnetti, Carmela; Gori, Andrea; Saracino, Annalisa; Bandera, Alessandra; Marchetti, Giulia; Girardi, Enrico; Mussini, Cristina; d'Arminio Monforte, Antonella; Antinori, Andrea. - In: INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES. - ISSN 1201-9712. - 142:(2024), pp. 1-34. [10.1016/j.ijid.2024.106995]

Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late for HIV diagnosis – results from the Icona cohort in Italy, 2009-2022

Cozzi-Lepri, Alessandro;Mussini, Cristina;
2024

Abstract

Background: Limited data are available on long-term outcomes in recent years for late HIV diagnosis (LD). Methods: All HIV-positive subjects enrolled in Icona Cohort in 2009-2022 starting ART within 4-months from diagnosis were included and divided into:1) pre-ART CD4 count≥350/mm3 without AIDS (non-LD), 2) pre-ART CD4 count<350/mm3 without AIDS (LD-Asymptomatic), 3) with AIDS events pre-ART (LD-AIDS). Estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure (TF) were evaluated. Results: 6,813 participants: 2,448 non-LD, 3,198 LD-Asymptomatic, and 1,167 LD-AIDS, 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD compared to non-LD (p<0.001), and within the former, for LD-AIDS over LD-Asymptomatic (p<0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD aHR=5.51, p<0.001), and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR=4.42, p<0.001), AIDS-related (aSHR=16.86, p<0.001) and not AIDS-related mortality (aSHR=1.74, p=0.022) compared to the rest of the late presenters. Among short-term survivors LD-AIDS, the long-term mortality was mediated by the lack of immune-recovery at 2-years. LD compared to non-LD, and particularly among the former, LD-AIDS over LD-Asymptomatic, showed also a greater risk of TF. Conclusions: In recent years, LD subjects, particularly AIDS-presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.
2024
142
1
34
Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late for HIV diagnosis – results from the Icona cohort in Italy, 2009-2022 / Mondi, Annalisa; Cozzi-Lepri, Alessandro; Tavelli, Alessandro; Cingolani, Antonella; Giacomelli, Andrea; Orofino, Giancarlo; De Girolamo, Gabriella; Pinnetti, Carmela; Gori, Andrea; Saracino, Annalisa; Bandera, Alessandra; Marchetti, Giulia; Girardi, Enrico; Mussini, Cristina; d'Arminio Monforte, Antonella; Antinori, Andrea. - In: INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES. - ISSN 1201-9712. - 142:(2024), pp. 1-34. [10.1016/j.ijid.2024.106995]
Mondi, Annalisa; Cozzi-Lepri, Alessandro; Tavelli, Alessandro; Cingolani, Antonella; Giacomelli, Andrea; Orofino, Giancarlo; De Girolamo, Gabriella; Pinnetti, Carmela; Gori, Andrea; Saracino, Annalisa; Bandera, Alessandra; Marchetti, Giulia; Girardi, Enrico; Mussini, Cristina; d'Arminio Monforte, Antonella; Antinori, Andrea
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