{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:40:47Z","timestamp":1789580447572,"version":"build-2803163510"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nObjectives<\/jats:title>\nWith the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV\/AIDS Research Network (CoRIS) during 2004\u20132018.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nCoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count \u2264350 cells\/\u03bcL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality).<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\n14,876 individuals were included. Overall, LP prevalence in 2004\u20132018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08).<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nLP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0249864","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T17:55:24Z","timestamp":1619027724000},"page":"e0249864","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":44,"title":["Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 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Public Health"},{"key":"pone.0249864.ref003","article-title":"Factors associated with late presentation for HIV care in a single Belgian reference center: 2006\u20132017","author":"G Darcis","year":"2018","journal-title":"Sci Rep"},{"key":"pone.0249864.ref004","article-title":"Patients who present late to HIV care and associated risk factors in Nigeria","author":"PA Agaba","year":"2014","journal-title":"HIV Med"},{"key":"pone.0249864.ref005","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jinf.2016.01.017","article-title":"Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004\u20132013","volume":"72","author":"P Sobrino-Vegas","year":"2016","journal-title":"J Infect"},{"key":"pone.0249864.ref006","author":"VIH Unidad de vigilancia del","year":"2020"},{"key":"pone.0249864.ref007","unstructured":"Ministerio de Sanidad, Servicios Sociales e Igualdad, Plan Nacional sobre Sida, Gu\u00eda de recomendaciones para el diagn\u00f3stico precoz de VIH en el \u00e1mbito sanitario, 2014"},{"key":"pone.0249864.ref008","doi-asserted-by":"crossref","first-page":"e1949","DOI":"10.1371\/journal.pone.0001949","article-title":"Late Entry to HIV Care Limits the Impact of Anti-Retroviral Therapy in the Netherlands.","volume":"3","author":"C Smit","year":"2008","journal-title":"PLoS One"},{"key":"pone.0249864.ref009","article-title":"Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients","author":"SM Ingle","year":"2014","journal-title":"Clin Infect Dis"},{"key":"pone.0249864.ref010","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/hiv.12567","article-title":"Predictors of CD4 cell recovery following initiation of antiretroviral therapy among HIV-1 positive patients with well-estimated dates of seroconversion","volume":"19","author":"OT Stirrup","year":"2018","journal-title":"HIV Med"},{"key":"pone.0249864.ref011","article-title":"HIV transmission rates from persons living with HIV who are aware and unaware of their infection","author":"H Irene Hall","year":"2012","journal-title":"AIDS"},{"key":"pone.0249864.ref012","article-title":"Vital signs: HIV transmission along the continuum of care\u2014United States, 2016","author":"Z Li","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"key":"pone.0249864.ref013","article-title":"Early HIV Diagnosis Leads to Significantly Decreased Costs in the First 2 Years of HIV Care in an Urban Charity Hospital in New Orleans.","author":"J Halperin","year":"2017","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"pone.0249864.ref014","first-page":"23","article-title":"[Spanish cohort of na\u00efve HIV-infected patients (CoRIS): rationale, organization and initial results]","volume":"25","author":"AM Caro-Murillo","year":"2007","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"pone.0249864.ref015","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1468-1293.2010.00857.x","article-title":"Late presentation of HIV infection: a consensus definition","volume":"12","author":"A Antinori","year":"2011","journal-title":"HIV Med"},{"key":"pone.0249864.ref016","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A Modified Poisson Regression Approach to Prospective Studies with Binary Data","volume":"159","author":"G Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"pone.0249864.ref017","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2020"},{"key":"pone.0249864.ref018","doi-asserted-by":"crossref","first-page":"e1001510","DOI":"10.1371\/journal.pmed.1001510","article-title":"Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE).","volume":"10","author":"A Mocroft","year":"2013","journal-title":"PLoS Med"},{"key":"pone.0249864.ref019","first-page":"7","article-title":"Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013","volume":"20","author":"J Berenguer","year":"2015","journal-title":"Eurosurveillance"},{"key":"pone.0249864.ref020","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1468-1293.2011.00958.x","article-title":"Late presentation for HIV diagnosis and care in Germany.","volume":"13","author":"A Zoufaly","year":"2012","journal-title":"HIV Med"},{"key":"pone.0249864.ref021","article-title":"Prevalence and risk factors of late presentation for HIV diagnosis and care in a tertiary referral centre in Switzerland: Presenting late with HIV-1.","author":"S Buetikofer","year":"2014","journal-title":"Swiss Med Wkly."},{"key":"pone.0249864.ref022","article-title":"Knowledge and Concern about STIs\/HIV and Sociodemographic Variables Associated with Getting Tested for HIV Among the General Population in Spain","author":"I Teva","year":"2018","journal-title":"J Psychol Interdiscip Appl"},{"key":"pone.0249864.ref023","article-title":"Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997\u20132007","author":"B Ndiaye","year":"2011","journal-title":"BMC Infect Dis"},{"key":"pone.0249864.ref024","article-title":"Risk factors for late HIV diagnosis in the East of England: evidence from national surveillance data and policy implications.","author":"RE Bath","year":"2019","journal-title":"Int J STD AIDS"},{"key":"pone.0249864.ref025","article-title":"Is self-perceived HIV risk congruent with reported HIV risk among traditionally lower HIV risk and prevalence adult emergency department patients? implications for HIV testing","author":"K Pringle","year":"2013","journal-title":"AIDS Patient Care STDS"},{"key":"pone.0249864.ref026","article-title":"Delayed HIV diagnosis and initiation of antiretroviral therapy: Inequalities by educational level","author":"R Zangerle","year":"2014","journal-title":"COHERE in EuroCoord. AIDS"},{"key":"pone.0249864.ref027","article-title":"HIV testing history and access to treatment among migrants living with HIV in Europe","author":"I Fakoya","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"pone.0249864.ref028","article-title":"Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review","author":"SJ Blondell","year":"2015","journal-title":"AIDS and Behavior"},{"key":"pone.0249864.ref029","article-title":"Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with hiv in a network of sti\/hiv counselling and testing clinics in spain","author":"A Diaz","year":"2015","journal-title":"Eurosurveillance"},{"key":"pone.0249864.ref030","article-title":"The impact of nontargeted HIV screening in emergency departments and the ongoing need for targeted strategies","author":"JS Haukoos","year":"2012","journal-title":"Archives of Internal Medicine"},{"key":"pone.0249864.ref031","article-title":"A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).","author":"MF Dom\u00ednguez-Berj\u00f3n","year":"2017","journal-title":"J Eval Clin Pract."},{"key":"pone.0249864.ref032","article-title":"Development and validation of an HIV risk exposure and indicator conditions questionnaire to support targeted HIV screening","author":"MJP Eli\u00e1s","year":"2016","journal-title":"Med (United States)."},{"key":"pone.0249864.ref033","article-title":"Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort","author":"SFL Van Lelyveld","year":"2012","journal-title":"AIDS"},{"key":"pone.0249864.ref034","article-title":"Risk of severe non AIDS events is increased among patients unable to increase their CD4 + T-cell counts >200+\/\u03bcl despite effective HAART","author":"G Lapadula","year":"2015","journal-title":"PLoS One"},{"key":"pone.0249864.ref035","doi-asserted-by":"crossref","first-page":"e0184329","DOI":"10.1371\/journal.pone.0184329","article-title":"Prediction of long-term outcomes of HIV-infected patients developing non-AIDS events using a multistate approach","volume":"12","author":"M Masi\u00e1","year":"2017","journal-title":"PLoS One"},{"key":"pone.0249864.ref036","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1097\/QAD.0b013e3283112b77","article-title":"HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies","volume":"22","author":"Monforte A d\u2019Arminio","year":"2008","journal-title":"AIDS"},{"key":"pone.0249864.ref037","article-title":"Serious fatal and nonfatal non-AIDS-defining illnesses in Europe","author":"A Mocroft","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0249864.ref038","article-title":"Contribution of Oxidative Stress to Non-AIDS Events in HIV-Infected Patients","author":"M Masi\u00e1","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0249864.ref039","article-title":"Relationship between current level of immunodeficiency and non-acquired immunodeficiency syndrome-defining malignancies","author":"J Reekie","year":"2010","journal-title":"Cancer"},{"key":"pone.0249864.ref040","article-title":"Cancer risk in HIV-infected persons: Influence of CD4+count","author":"GM Clifford","year":"2009","journal-title":"Future Oncology"},{"key":"pone.0249864.ref041","article-title":"Where is the greatest impact of uncontrolled HIV infection on AIDS and non-AIDS events in HIV?","author":"A Mocroft","year":"2018","journal-title":"AIDS"},{"key":"pone.0249864.ref042","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1111\/hiv.12292","article-title":"Late presentation to HIV testing is overestimated when based on the consensus definition","volume":"17","author":"A Sasse","year":"2016","journal-title":"HIV Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0249864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T17:56:06Z","timestamp":1619027766000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0249864"}},"subtitle":[],"editor":[{"given":"Graciela","family":"Andrei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,21]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0249864","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,21]]}}}