{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:21:50Z","timestamp":1790097710590,"version":"4.0.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:00:00Z","timestamp":1675814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009947","name":"merck sharp and dohme","doi-asserted-by":"publisher","award":["SDD 343462"],"award-info":[{"award-number":["SDD 343462"]}],"id":[{"id":"10.13039\/100009947","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005564","name":"gilead sciences","doi-asserted-by":"publisher","award":["215001269"],"award-info":[{"award-number":["215001269"]}],"id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010877","name":"viiv healthcare","doi-asserted-by":"publisher","award":["14-0614-ViiV"],"award-info":[{"award-number":["14-0614-ViiV"]}],"id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008897","name":"janssen pharmaceuticals","doi-asserted-by":"publisher","award":["771290"],"award-info":[{"award-number":["771290"]}],"id":[{"id":"10.13039\/100008897","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material and methods<\/jats:title>\n<jats:p>We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4&gt;350cells\/\u03bcL), late presentation (CD4 200-350cells\/\u03bcL or &gt;350cells\/\u03bcL with AIDS-defining illness) and very late presentation (CD4&lt;200cells\/\u03bcL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was \u20ac12,902 (SD\u20ac11,098), of which about two-thirds due to ART (\u20ac8,250 (SD\u20ac3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (\u20ac4,749 (SD\u20ac8,009)) and very late presentation (\u20ac15,886 (SD\u20ac 21,834)), compared with timely presentation (\u20ac2,407(SD\u20ac4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0280877","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T18:27:37Z","timestamp":1675880857000},"page":"e0280877","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8959-4671","authenticated-orcid":true,"given":"Stephanie","family":"Popping","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbeth","family":"Versteegh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke E.","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A. M. C.","family":"van de Vijver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6656-0516","authenticated-orcid":true,"given":"Ard","family":"van Sighem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7896-6428","authenticated-orcid":true,"given":"Peter","family":"Reiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Geerlings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A. B.","family":"Boucher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelies","family":"Verbon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ATHENA observational cohort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"issue":"1","key":"pone.0280877.ref001","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"},{"issue":"9","key":"pone.0280877.ref002","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMoa1506816","article-title":"Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection","volume":"373","author":"ISS 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