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Open Access Research article

Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study

Collins C Iwuji12*, Duncan Churchill1, Yvonne Gilleece1, Helen A Weiss3 and Martin Fisher1

Author Affiliations

1 Lawson Unit, Department of HIV/Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, United Kingdom

2 Africa Centre for Health and Population Studies, University of KwaZulu-Natal, P.O. Box 198, Mtubatuba 3935, South Africa

3 MRC Tropical Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK

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BMC Public Health 2013, 13:397  doi:10.1186/1471-2458-13-397

Published: 26 April 2013

Abstract

Background

Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm3) and mortality.

Methods

Patients newly diagnosed with HIV infection at a UK clinic were recruited from January 1996 to May 2010. Factors associated with late presentation were assessed using logistic regression. Factors associated with mortality rates were analysed using Poisson regression.

Results

Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mm3 at presentation (“late presentation”). The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual.

The mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40).

Conclusions

Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50.

Keywords:
HIV; Late presentation; Older adults; Mortality; CD4 cell count