Barcelona 2013
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| Abstract #396 - Psychological state | ||||
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Session: 6.8: Psychological state (Parallel) on Monday @ 11.00-13.00 in Auditorio Chaired by Barbara Hedge, Susannah Allison Authors: Presenting Author: Dr Kayigan Wilson d'Almeida - INSERM-UVSQ, France |
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| Additional Authors: | ||||
| Aim: In France, new HIV diagnoses have declined since 2003 in native and migrant heterosexual groups, while it has remained stable in men who have sex with men (MSM) with an estimated 1% yearly incidence of new infections. In the meantime, surveys show an increase in HIV risk behaviors and high rates of testing among that population. However in 2011, 21% of MSM were still diagnosed late (CD4 cell count <200 or AIDS event). Early diagnosis and antiretroviral treatment are viewed as additional preventive tools to reverse the trend of the epidemic among MSM. We assessed the factors associated with late presentation or presentation with advanced HIV disease MSM in France. | ||||
| Method / Issue: We used data from the ANRS Vespa2 study, a large cross-sectional survey, conducted in 2011 in outpatient clinics which recruited 3022 participants representative of the French HIV infected population. Patients answered a face-to-face standardized questionnaire administered by a trained interviewer and CD4 counts at diagnosis were documented from medical records. The analyses were carried out on the subpopulation of 480 MSM diagnosed between 2003 and 2011. Late presentation was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 <350/mm3 and presentation with HIV advanced disease was defined as presentation with either clinical AIDS events or CD4 <200/mm3. Socio-demographic and sexual characteristics collected included age, region of residence, education, country of birth, having migrant parents, self-defined sexual orientation, religion, illegal drug use (other than cannabis) at HIV diagnosis and number of lifetime male and female sexual partners. The association between those variables and the two outcomes were assessed through univariate and multivariate logistic modeling. | ||||
| Results / Comments: The median age at HIV diagnosis among MSM was 37 years [IQR=30-46]; 21.5% presented with an advanced HIV disease and 38.1% were classified as late presenters. Year of diagnosis, region of residence, country of birth, having migrant parents, numbers of lifetime male partners, religion were not statistically associated with late presentation nor presentation with HIV advanced disease. The proportion of presentation with advanced HIV disease increased with age and was lower among MSM using drugs, individuals with high level of education and individuals who defined themselves as homosexuals compared to bisexuals (OR=0.5, 95% CI=[0.4-0.7]). The same variables were associated to late presentation which was also found to be higher in men declaring more than 20 female partners. In multivariate analyses, only age at diagnosis was found associated with either presentation with advanced HIV disease or late presentation (for men >50 vs. <30 years respectively: ORs, 95% CIs: 13.3 [4.5-38.9] and 8.3 [1.9-36.4]). | ||||
| Discussion: Our results show that the main factor associated with late presentation and presentation with advanced HIV disease is age. They also suggest that MSM who do not self-define as gay and with a history of bisexual behavior are more likely to be late presenters. Promotion of HIV testing should be renewed to target the whole MSM population, including programs targeting older men (above 50) and men with bisexual behavior who might live their homosexuality outside the gay culture. | ||||
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