Increasing proportion of late diagnosis of HIV infection among patients with AIDS in Italy following introduction of combination antiretroviral therapy

We analyzed trends over time and determinants of late diagnosis of HIV infe ction among people diagnosed with AIDS in 1986 to 1998 in a tertiary care c enter in Rome, Italy. Information on the date of a first HIV test was colle cted prospectively, in addition to data routinely collected for AIDS report ing. Patients with AIDS were defined as "late testers" if the time interval between first positive HIV test result and AIDS diagnosis was less than or equal to3 months. Overall, 503 people with AIDS of 1977 included in the an alysis (25.4%) were late testers, the proportion of late testers decreased from 62.5% in 1986 to 16% in 1995. Thereafter, this proportion increased to 20.5% in 1996, 33.7% in 1997, and 36.6% in 1998. In multivariate analysis, the following variables were significantly associated with late testing: A IDS diagnosis in years 1986 to 1993 or 1997 to 1998 compared with 1995, mal e gender, age greater than or equal to 45 years, men who have sex with men, heterosexual contacts, or having unknown transmission mode compared with i ntravenous drug users, and being born outside Italy. Since 1996, the overal l number of AIDS cases diagnosed at our center began to decrease whereas th e number of late-testing AIDS patients did not decrease, resulting in an in creasing proportion of late testers during the last 3 years of the study. T his findings may reflect the effect of combination antiretroviral therapy i n slowing progression to AIDS of HIV-infected persons aware of their status . A relevant number of people still discover their HIV infection late and m ay therefore miss treatment opportunities. New testing strategies are neede d to reach more people who engage in high-risk behaviors, especially those at risk for sexual transmission, and those born outside Italy.