{
  "abstract": "Background Late HIV diagnosis remains an ongoing and important problem in the public health. In 2024 in the countries of the European Union, almost half of the newly diagnosed HIV people were diagnosed several years post-infection, suggested by a CD4 count below 350 cells/mm 3 and one third of people with advanced HIV infection (CD4 count below 200 cells/mm3) (1). In the same year in Italy the proportion of late HIV diagnosis was 60% and 25% of all new diagnoses were AIDS presenters (2). The aim of this study is to analyze the trends and the factors associated with being diagnosed late among persons with a new HIV diagnosis in Italy from 2012 to 2024.Material and Methods Data on new HIV diagnoses reported by the HIV surveillance system between 2012 and 2024 was used. Late diagnosis (LD) is defined as a CD4 cell count < 350 cells/mm3 or AIDS presenter at first HIV diagnosis, unless there is evidence of recent infection (3). We then used a binary logistic regression model to assess risk factors for late HIV diagnosis, including year of diagnosis, age group at HIV diagnosis, mode of transmission, nationality, and reporting area (Northern, Central, Southern Italy).Results Between 2012 and 2024 38,909 HIV diagnoses were reported to the Italian Surveillance System. Out of them, 32,966 (84,7%) had data on CD4 cell counts. Late diagnoses (LD) accounted for 54.4%. The proportion of LD shows a slow and gradual increase over time until 2019 (52.7% in 2012; 54.5% in 2019) and more pronounced in the last three years (54.9% in 2022; 56.6% in 2024). The median age of LD was 43 years (IQR 34-52), the highest proportions of LD were among people older than 50 years of age (70.5%), heterosexual males (65.5%), heterosexual females (57.7%), and people diagnosed in Southern Italy (56%). At multivariate analysis, the risk of LD increased with age: 25-39 ys OR = 1.85 (95% CI 1.69-2.17); 40-49ys OR=3.23 (95% CI 2.94-3.54); older than 50ys OR=5.16 (95% CI 4.68-5.69), compared to less than 25 ys. At multivariate analysis, factors significantly associated with LD were: having been diagnosed in Central or Southern Italy vs. Northern Italy OR = 1.22 (95% CI 1.15-1.29); being non-national vs Italian, OR 1.43 (95% CI 1.36-1.52); heterosexual transmission (male) OR = 1.96 (95% CI 1.85-2.08), heterosexual transmission (female) OR = 1.56 (95% CI 1.46-1.66), IDU transmission OR = 1.30 (95% CI 1.16-1.45) compared to MSM transmission.Conclusions The proportion of LD continuously increased in the study period, especially in the last three years. Older people, heterosexual males, non-Italians and people diagnosed in Central or Southern Italy showed a higher risk of LD. It is crucial to promote initiatives to reduce late HIV diagnosis, by facilitating and expanding access to test, promoting opt-out testing in various settings, and contrasting stigma.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Diseases, National Institute of Health, Rome, Italy"
      ],
      "name": "V Regine"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, National Institute of Health, Rome, Italy"
      ],
      "name": "L Pugliese"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, National Institute of Health, Rome, Italy"
      ],
      "name": "B Suligoi"
    }
  ],
  "title": "OC59 Trends and risk factors for late HIV diagnosis in Italy from 2012 to 2024",
  "uid": "abc179ad-6c0c-5a85-85a1-47a659b2d8a3"
}