Late HIV presentation in men who have sex with men in Portugal: Are there target groups for testing promotion?

Late HIV diagnosis is associated with increased morbidity and mortality, and missed opportunities to reduce the population frequency of high-risk contacts. We describe characteristics of late HIV presenters (LP) among men who have sex with men (MSM) in a concentrated epidemic country.

Data was obtained during the European MSM Internet Survey that took place from June 4 to August 21, 2010. An anonymous questionnaire was completed online (35 European countries using 25 languages) comprising 5187 subjects living in Portugal. Data included HIV testing, HIV status, CD4-count at diagnosis, sociodemographic and behavioral characteristics. LP was defined as <350 CD4 at diagnosis. Proportions were compared using the Chi-squared test.

Among the 3723 (71.8%) men who ever received an HIV test result, 405 (10.9%) reported to be positive, 186 knew their CD4 count at diagnosis, and 69 (37.1%) were LP. Older MSM (≥ 40 years)  were more often LP than younger MSM (<25 and 25-39 years) (46.2% vs 38.9% vs 32.8%); MSM with a lower educational level reported LP more often (56.3% vs. 43.3%, medium vs. 30.6% higher, p=0.06); LP was similar in men born in Portugal or abroad (38.1% vs. 37.7%)  but more frequent in participants with history of drug injection (61.5% vs. 35.9%, p=0.06). Late presenters were more commonly diagnosed hospital inpatients (64.3% vs. 34.9% in other sites p=0.029)

Late presenters did not significantly differ from remaining MSM in most usually assessed characteristics. Increasing the offer of HIV testing might benefit from a whole-population approach rather than a high-risk one.