Background: Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the\nCD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious\ncomorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP\nand HIV + EP, respectively), and compare them to matched HIV-negative control participants from a communitybased\ncohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in\nHIV patients.\nMethods: We performed a matched cohort study including HIV + LP and HIV + EP among people attending the\nModena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative\nparticipants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of â�¥2 NICM.\nLogistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity.\nResults: We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The\nmean age was 46 �± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the\nHIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated\nwith increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after\nadjusting for age, multimorbidity, and antiretroviral costs.\nConclusions: LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and\nmultimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently\nneeded.
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