Socio-demographic and psycho-social determinants of HIV late presentation in Germany – results from the FindHIV study

ABSTRACT

Delayed HIV diagnosis at advanced stages of disease remains common (33%–64%). This analysis of the multi-center FindHIV study including newly diagnosed HIV-infected adults in Germany, focused on the potential role of socio-demographic and psychological factors on late diagnosis (formerly “late presentation”, AIDS diagnosis or CD4 cells <350/µL). These data were collected from patient profiles, physician-patient interviews and questionnaires. Participating centers (n = 40) represented the diverse health care settings in HIV care and geographic regions. Of 706 newly diagnosed adults (92% male, median age 39 years) between 2019 and 2020, 55% (388/706) were diagnosed late with a median CD4 cell count of 147/µL; 20% (142/706) presented with AIDS. From the physicians’ perspective, earlier diagnosis would have been possible in 45% of participants (late versus non-late presentation 58% versus 29%). The most common physician-perceived reason was an underestimated risk for HIV infection by the patient (37%). In multivariable logistic regression analysis, older age, sexual contacts with both sexes as possible route of HIV transmission, being married, and a poor level of knowledge about HIV treatment were found to be associated with a significantly elevated risk for late presentation. Education, employment status, sexual relations, migration background and personality traits were not.

Trial registration: German Clinical Trials Register (DRKS00016351).

KEYWORDS:

• HIV
• human immunodeficiency virus
• AIDS
• late presentation

Acknowledgements

We thank all participating centers: Arztpraxis Rößler, Zwickau; Centrum für interdisziplinäre Medizin, Münster; Dammtor Praxis, Hamburg; Gemeinschaftsklinikum Mittelrhein, Koblenz; Gemeinschaftspraxis Dr. Ulmer/Dr. Müller/Dr. Frietsch/Dr. Roll, Stuttgart; Gemeinschaftspraxis Mosthaf, Karlsruhe; Medcenter, Chemnitz; ICH Study Center, Hamburg; ifi-Studien, Hamburg; Infektio Research, Frankfurt; Infektiologie Schwabing, München; Isarpraxis Dr. Becker/Dr. Pauli, München; Praxis Dr. Knechten, Aachen; Medcenter, Weimar; MVZ Medicover Ulm; MVZ Dres. Mauss/Schmutz/Athmann/Hegener, Düsseldorf; MVZ München am Goetheplatz; Novopraxis, Berlin; Praxis City Ost, Berlin; Praxis Cordes, Berlin; Praxis Eimsbüttel, Hamburg;Praxis Dr. Ines Ruck, Leipzig; Praxis Ebertplatz, Köln; Dr. Scholten & Schneeweiß, Köln; Praxis Kreuzberg, Berlin; prinzmed, München; Studienzentrum Berlin Prenzlauer Berg, Berlin; EPIMED, Berlin; Klinikum rechts der Isar der Technischen Universität München; Klinikum Leverkusen; Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Bonn; Universitätsklinikum Essen, Dermatologie; Universitätsklinikum Essen, Innere Medizin; Universitätsklinikum Frankfurt; Universitätsklinik Jena; Klinikum der Universität München; Universitätsklinikum Schleswig-Holstein, Campus Lübeck; Universitätsklinikum Freiburg. Prior to study initiation, ethics approval was obtained from the medical faculty of the University of Duisburg-Essen (application number: 18-8263-BO). Where necessary, local and regional ethic approvals from the competent institutional review boards were obtained. All study participants provided written informed consent prior to enrolment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

FindHIV is funded by the innovation fund of the “Gemeinsamer Bundesausschuss” (Federal Joint Committee) (project number: 01VSF17041).