Deficiencies in the health care system contribute to a high rate of late <scp>HIV</scp> diagnosis in Sweden

Brännström, Johanna; Johansson, Veronica Svedhem; Marrone, Gaetano; Wendahl, S; Yilmaz, Aylin; Blaxhult, Anders; Sönnerborg, Anders

doi:10.1111/hiv.12321

Cited by 45 publications

(74 citation statements)

References 28 publications

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“…25 A majority (57%) of WLWH in our study had at one point been highly immunosuppressed (median nadir CD4 count 178 cells/lL), which in the majority of cases is due to late HIV diagnosis. 26 As shown earlier, 7,21,22 the risk of highgrade cervical intraepithelial neoplasia increased with immunosuppression among our patients. This indicates the importance of an early HIV diagnosis since an early start of ART will prevent the development of immunosuppression.…”

Section: Discussionsupporting

confidence: 76%

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden

Carlander

Wagner

Svedhem

et al. 2016

Intl Journal of Cancer

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Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN31) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN21 and CIN31 in a cohort of women living with HIV (WLWH) (n 5 893) identified from the Swedish national HIV register and HIV-negative women (n 5 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN31 was 13.1% [95% confidence interval (CI) 8.9-17.2] for WLWH and 2.1% (95% CI 2.0-2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN31 than HIV-negative (HR 8.8: 95% CI 6.9-11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN31 compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2-5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN31 among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia.Women living with HIV (WLWH) are more likely than HIV-negative women to have persistent high risk-Human Papillomavirus (hr-HPV) cervical infections 1,2 and to develop cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN31). 3,4 The risk of CIN31 increases with the degree of immunosuppression [5][6][7]

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Section: Discussionsupporting

confidence: 76%

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden

Carlander

Wagner

Svedhem

et al. 2016

Intl Journal of Cancer

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“…The vast majority of LP in Sweden are migrants [6], but in the present study we showed that symptomatic patients from high prevalent countries were less likely to be missed by the physician at seeking health care and also to neglect their symptoms, compared to patients born in Sweden. The finding of a higher testing rate of migrants shows a good adherence to the epidemiological indicators for testing among health care professionals [17].…”

Section: Discussionmentioning

confidence: 48%

“…This cohort represented three quarters of all newly diagnosed patients from all parts of the country with an equal geographical distribution including the major cities and county clinics and has previously been described in detail [6]. All participants provided their written informed consent and the study was approved by the Regional Ethical Review Board in Stockholm, Sweden (2009/1029-31/1-4).…”

Section: Methodsmentioning

confidence: 99%

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Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study

Brännström¹,

Svedhem²,

Marrone³

et al. 2016

PLoS ONE

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ObjectivesOne quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis.MethodsA national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed.ResultsThe odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05.ConclusionsIndividuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.

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Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study

Deen

Cowan²,

Wejse

et al. 2018

Infection

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Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden

Cited by 45 publications

References 28 publications

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden

Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study

Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study

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