Did the COVID-19 pandemic shift the landscape of late HIV diagnosis?

Background The COVID-19 pandemic profoundly disrupted healthcare services. This study assessed the impact of the pandemic on the incidence, characteristics, and outcomes of late HIV diagnosis (LD) in Italy. Methods All people with HIV (PWH) enrolled in Italian Cohort Naïve Antiretrovirals during 2016-2019 (prepandemic) and 2021-2024 (postpandemic), and diagnosed with HIV within 3 months before enrolment, were included. LD was defined as CD4 ' 350 cells/mm³ or an AIDS-defining event (ADE) within 3 months of HIV diagnosis; AIDS presentation (AIDS-P) was considered an ADE at diagnosis. Annual incidence, socio-demographic determinants, and survival outcomes were compared between periods using Poisson regression, Cox proportional hazards models, and Fine–Gray competing risk models. Results Among 5724 newly diagnosed PWH, 56% were enrolled in prepandemic and 44% postpandemic. Overall, 58% presented late and 13% as AIDS-P, with proportions stable across periods. Risk factors for LD—female sex, older age, foreign nationality, heterosexual transmission, lower education, and unemployment—remained consistent, with no significant interaction by time (P = 0.39). During follow-up, 151 deaths occurred. LD and especially AIDS-P were associated with substantially increased all-cause mortality compared with non-LD, particularly within the first-year postdiagnosis. Adjusted hazard ratios were 2.96 for LD and 6.51 for AIDS-P prepandemic, and 8.64 and 17.99 postpandemic. No excess risk was observed for non-AIDS-related mortality. Conclusion The prevalence and determinants of LD and AIDS-P in Italy remained stable before and after the COVID-19 pandemic. However, late presentation continues to carry a heavy mortality burden, underscoring the urgent need to strengthen early testing and prompt linkage to care.