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Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort
  1. Eline L M Op de Coul1,
  2. Ard van Sighem2,
  3. Kees Brinkman3,
  4. Birgit H van Benthem1,
  5. Marchina E van der Ende4,
  6. Suzanne Geerlings5,
  7. Peter Reiss2
  8. for the ATHENA national observational HIV cohort
    1. 1Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
    2. 2Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
    3. 3Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
    4. 4Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
    5. 5Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
    1. Correspondence to Dr Eline LM Op de Coul;{at}


    Objectives 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.

    Methods 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.

    Results 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.

    Conclusions 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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