Late testing for human immunodeficiency virus in a Puerto Rican cohort

Late HIV testing (LT) defined as an AIDS diagnosis within a year of first positive HIV test, is associated with increased HIV transmission, decreased HAART effectiveness, and worse outcomes. Latinos disproportionately represent 36% of LT in the United States. Factors associated with LT such as older age, IDU, and serostatus unawareness are prevalent in the Latino population, particularly among Puerto Ricans. We used logistic regression and Cochran-Armitage tests to identify factors associated with and describe trends of LT in a cohort of 795 HIV-infected individuals entering the Universidad Central del Caribe Retrovirus Research Center Cohort within one year of first reported HIV-positive test. During 2000 through 2011, 47% (n=377) of the 795 individuals were classified as LT cases. LT individuals presented with lower CD4 T cells counts and higher HIV viral load than non-LT cases. In a mutually adjusted model, male gender (OR=1.53, 95% CI: 1.13, 2.09); older age (30-44 years [OR=1.65, CI: 1.06, 2.56] and ≥45 years [OR=3.29, CI: 2.07, 5.23]); and reporting a remote history of IDU (OR=2.15, CI: 1.13, 4.08) were positively associated with LT, whereas amphetamine users had a lower odds of LT (OR=0.49, CI: 0.30, 0.82). Overall LT prevalence decreased from 47% in 2000 to 36% in 2011. However, this decline was statistically significant only among MSM. Given the high prevalence of LT in this Puerto Rican cohort, culturally sensitive interventions targeting early HIV testing, are recommended particularly for highest Puerto Rican subgroups including males, older patients and persons with a history of IDU.