Association of demographics, HCV co‐infection, HIV‐1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV‐1 Surveillance Network
Authors: Otani Machiko , Shiino Teiichiro , Hachiya Atsuko , Gatanaga Hiroyuki , Watanabe Dai , Minami Rumi , Nishizawa Masako , Teshima Takanori , Yoshida Shigeru , Ito Toshihiro , Hayashida Tsunefusa , Koga Michiko , Nagashima Mami , Sadamasu Kenji , Kondo Makiko , Kato Shingo , Uno Shunsuke , Taniguchi Toshibumi , Igari Hidetoshi , Samukawa Sei , Nakajima Hideaki , Yoshino Yusuke , Horiba Masahide , Moro Hiroshi , Watanabe Tamayo , Imahashi Mayumi , Yokomaku Yoshiyuki , Mori Haruyo , Fujii Teruhisa , Takada Kiyonori , Nakamura Asako , Nakamura Hideta , Tateyama Masao , Matsushita Shuzo , Yoshimura Kazuhisa , Sugiura Wataru , Matano Tetsuro , Kikuchi Tadashi ,   Japanese Drug Resistance HIV‐1 Surveillance Network
Published: May 2023

Introduction

Late diagnosis of the human immunodeficiency virus (HIV) is a major concern epidemiologically, socially and for national healthcare systems. Although the association of certain demographics with late HIV diagnosis has been reported in several studies, the association of other factors, including clinical and phylogenetic factors, remains unclear. In the present study, we conducted a nationwide analysis to explore the association of demographics, clinical factors, HIV‐1 subtypes/circulating recombinant form (CRFs) and genetic clustering with late HIV diagnosis in Japan, where new infections mainly occur among young men who have sex with men (MSM) in urban areas.

Methods

Anonymized data on demographics, clinical factors and HIV genetic sequences from 39.8% of people newly diagnosed with HIV in Japan were collected by the Japanese Drug Resistance HIV‐1 Surveillance Network from 2003 to 2019. Factors associated with late HIV diagnosis (defined as HIV diagnosis with a CD4 count <350 cells/μl) were identified using logistic regression. Clusters were identified by HIV‐TRACE with a genetic distance threshold of 1.5%.

Results

Of the 9422 people newly diagnosed with HIV enrolled in the surveillance network between 2003 and 2019, 7752 individuals with available CD4 count at diagnosis were included. Late HIV diagnosis was observed in 5522 (71.2%) participants. The overall median CD4 count at diagnosis was 221 (IQR: 62–373) cells/μl. Variables independently associated with late HIV diagnosis included age (adjusted odds ratio [aOR] 2.21, 95% CI 1.88–2.59, ≥45 vs. ≤29 years), heterosexual transmission (aOR 1.34, 95% CI 1.11–1.62, vs. MSM), living outside of Tokyo (aOR 1.18, 95% CI 1.05–1.32), hepatitis C virus (HCV) co‐infection (aOR 1.42, 95% CI 1.01–1.98) and not belonging to a cluster (aOR 1.30, 95% CI 1.12–1.51). CRF07_BC (aOR 0.34, 95% CI 0.18–0.65, vs. subtype B) was negatively associated with late HIV diagnosis.

Conclusions

In addition to demographic factors, HCV co‐infection, HIV‐1 subtypes/CRFs and not belonging to a cluster were independently associated with late HIV diagnosis in Japan. These results imply the need for public health programmes aimed at the general population, including but not limited to key populations, to encourage HIV testing.