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Determinants of HIV late presentation among men who have sex with men in Portugal (2014–2019): who’s being left behind?

2024; Frontiers Media; Volume: 12; Linguagem: Inglês

10.3389/fpubh.2024.1336845

2296-2565

Ricardo Abrantes, Victor Pimentel, Mafalda Miranda, Ana Rita Silva, António Diniz, Bianca Branco Ascenção, Carmela Piñeiro, Carmo Koch, Catarina Rodrigues, Cátia Caldas, Célia Morais, Domitília Faria, Elisabete Gomes da Silva, Eugénio Teófilo, Fátima Monteiro, Fausto Roxo, Fernando Maltêz, Fernando Rodrigues, Guilhermina Gaião, Helena Ramos, Inês Costa, Isabel Germano, Joana Simões, Joaquim Oliveira, José A. Ferreira, José Poças, José Saraiva da Cunha, Jorge Soares, Sandra Bianchini Fernandes, Kamal Mansinho, Liliana Pedro, Maria João Aleixo, Maria João Gonçalves, Maria José Manata, Margarida Mouro, Margarida Serrado, Micaela Caixeiro, Nuno Marques, Olga Costa, Patrícia Pacheco, Paula Proença, Paulo Rodrigues, Raquel Pinho, Raquel Tavares, Ricardo Correia de Abreu, Rita Côrte‐Real, Rosário Serrão, Rui Sarmento e Castro, Sofia Nunes, Telo Faria, Teresa Baptista, Daniel Simões, Luís Mendão, Maria do Rosário Oliveira Martins, Perpétua Gómes, Marta Pingarilho, Ana Abecasis,

HIV Research and Treatment

Introduction HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results The median age was 31 years, 51% had a current income between 501–1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.