Late HIV presentation – missed opportunities and factors associated with a changing pattern over time

Abstract

Delayed diagnosis of HIV infection has negative clinical, economic and public health implications. The study primary aim was to identify factors associated with late HIV presentation (Late Presenters [LPS], CD4 cell count < 350 cells/mm). A secondary aim was to identify changing trends of late HIV presentation from 2002 to 2014 at our centre. A retrospective cohort study was performed. Demographic data and CD4 cell count of new HIV diagnoses presenting to our ambulatory HIV service over four time-periods from 2002 to 2014 were recorded. Proportion of LPS and factors associated with late presentation were compared using Graphpad Instat. In 2014, of 231 new patients attending for HIV care, 75 (32.6%) were late presenters versus 146 (66.4%) in 2002. This indicates a decreasing proportion of LPS from 2002 to 2014. However, the proportion of those with CD4 cell counts <200 on presentation at these two time intervals remain unchanged. The overall proportion of male LPS has increased over time and the proportion of LPS in the men who have sex with men (MSM) cohort has decreased over time, reflecting increased frequency of both HIV testing and diagnoses in MSM in recent years. The proportion of heterosexual LPS has not changed significantly in the same time period and LPS were older in 2014 versus 2002. The proportion of LPS defined by CD4 cell count remains higher than is justifiable in an era of increased HIV testing and awareness. Further targets for HIV testing to decrease rates of LPS include non-traditional risk groups including heterosexual and older patient cohorts. LPS rates are lower than rates found internationally, and it is possible that consensus definition of LPS needs to be revised.

AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan

“…Although the contribution of heterosexuals for HIV transmission is lower than that of gbMSMs, the findings reveal significantly higher LP prevalence among heterosexuals than in gbMSMs [adjusted OR (95% CI), 1.54 (1.40–1.70)] and an upward trend of LP among heterosexuals ( P for trend < 0.001); this warrants a critical rethink of the HIV prevention strategies for both heterosexuals and gbMSMs in Taiwan. The finding of higher LP prevalence among heterosexuals in the present study is consistent with findings from other studies [ 5 , 27 ], and may be attributable to the lower HIV testing rates among heterosexuals [ 28 ]. One explanation for this is the particular history of the HIV epidemic in Taiwan.…”

Factors associated with late presentation for HIV care in a single Belgian reference center: 2006–2017

“…Additionally, healthcare providers may consider HIV testing less often in individuals who are not perceived as being at high risk of HIV such as older individuals or heterosexuals, leading to missed opportunities for HIV diagnosis. High rates of missed opportunities for HIV diagnosis have previously been reported, highlighting the ongoing need for physician education on HIV testing and clinical signs suggestive of HIV infection 31 , 32 . This is particularly relevant for people aged 50 years since this group would benefit most from immediate initiation of ART as recently shown in a post-hoc subgroup analysis of the START trial 10 .…”

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China

“…Recent studies in developed countries have demonstrated that non-traditional risk groups including women, heterosexual individuals and older adults are more likely to be tested later in the course of HIV infection [7–9]. These data provide important information for policy-making regarding HIV screening strategies in those settings.…”