National review of deaths among HIV-infected adults

Lucas, SB; Curtis, Hilary; Ma, Jun

doi:10.7861/clinmedicine.8-3-250

Cited by 44 publications

(32 citation statements)

References 13 publications

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“…2 A national audit looking at causes of death in patients living with HIV showed that presenting for care too late for effective treatment was significantly associated with subsequent death. 3 These HIV infected patients who are unaware of their status are at particular risk of harm as they can present late to care without the diagnosis being immediately apparent to those caring for them, and may have had repeated contact with health care professionals without being offered an HIV test. 4 In 2008 new National Guidelines for HIV testing 5 were issued which stated that-▸ HIV is now a treatable medical condition with a good prognosis if detected early ▸ Improving levels of detection will help reduce onward transmission ▸ HIV testing should be offered as routine in certain clinical settings or when patients present with particular indicator conditions ▸ It should be within the competence of any doctor, midwife, nurse or trained healthcare worker to obtain consent for and conduct an HIV test.…”

Section: Introductionmentioning

confidence: 99%

HIV testing for acute medical admissions: evaluation of a pilot study in Leicester, England

et al. 2012

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ObjectivesThe 2008 UK National Guidelines for HIV testing recommended HIV testing should be offered to all general medical admissions aged 16–60 years in high prevalence areas, and that this should be evaluated to ensure this was effective in diagnosing previously undiagnosed HIV.MethodsHIV testing was introduced as a routine test for all patients admitted to the acute medical admissions unit, comparisons were made between the testing rates before, during and after this intervention.ResultsThe pilot was initiated in August 2009. Prior to the pilot the unit was carrying out 15 tests per month. However, when the pilot was introduced 82 tests were being carried out per month with a total of 10 new diagnoses since the start of the pilot. The proportion of patients tested versus those eligible for testing remained low varying between 6% and 22% month by month. 10 patients we found to be HIV positive with a prevalence of approximately 1%, 10 fold higher than the cut off for cost effectiveness used in the guidelines.ConclusionsOverall the pilot showed that HIV testing could be delivered without the use of extra resources and is acceptable to patients.

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Section: Introductionmentioning

confidence: 99%

HIV testing for acute medical admissions: evaluation of a pilot study in Leicester, England

et al. 2012

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“…A national audit of deaths among HIV infected adults found that late diagnosis was the leading remediable cause of HIV-related death [7]. The responsibilities of all health workers and services in reducing the diagnosis gap has been emphasised by leaders across disciplines [9].…”

Section: Introductionmentioning

confidence: 99%

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

2012

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BackgroundLate diagnosis is an important cause of HIV-related morbidity, mortality and healthcare costs in the UK and undiagnosed infection limits efforts to reduce transmission. National guidelines provide recommendations to increase HIV testing in all healthcare settings. We evaluated progress towards these recommendations by comparing missed opportunities for HIV testing and late diagnosis in two six year cohorts from North East Scotland.MethodsWe reviewed diagnostic pathways of all patients newly diagnosed with HIV referred to infectious diseases and genito-urinary medicine services between 1995 and 2000 (n = 48) and 2004 to 2009 (n = 117). Missed presentations (failure to diagnose ≤ 1 month of a clinical or non-clinical indicator for testing), late diagnosis (CD4 < 350 cells/mm3), and time to diagnosis (months from first presentation to diagnosis) were compared between cohorts using χ2 and log-rank tests. Determinants of missed presentation were explored by multivariate logistic regression. Breslow-Day tests assessed change in diagnostic performance by patient subgroup.ResultsThere were significant decreases in missed presentations (33% to 17%; P = 0.02) and time to diagnosis (mean 17 months to 4 months; P = 0.005) but not in late diagnosis (56% vs. 60%; P = 0.57) between earlier and later cohorts. In the later cohort patients were significantly more likely to have acquired HIV abroad and presented with early HIV disease, and testing was more likely to be indicated by transmission risk or contact with GUM services than by clinical presentation. Missed presentation remained significantly less likely in the later cohort (OR = 0.28, 95% CI 0.11 to 0.72; P = 0.008) after adjustment for age, transmission risks and number of clinical indicators. Reductions in missed presentation were greater in patients < 40 years, of non-UK origin, living in least deprived neighbourhoods and with early disease at presentation (P < 0.05). 27% of missed presentations occurred in primary care and 46% in general secondary care.ConclusionsWhile early diagnosis has improved in epidemiological risk groups, clinical indications for HIV testing continue to be missed, particularly in patients who are older, of UK origin and from more deprived communities. Increasing testing in non-specialist services is a priority.

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“…Non-AIDS causes in high-income countries account for at least a third of deaths, and include non-natural causes such as drug overdose, suicide, and violence along with various somatic diseases (Kohli et al, 2005;Krentz et al, 2005). Important non-HIV-related complications contributing to mortality of AIDS patients are chronic liver diseases, cardiovascular pathology and malignancies (d'Arminio Monforte, 2009;Friis-Møller et al, 2010;Lucas et al, 2008;Sackoff et al, 2006). Cases of hepatic involvement are extremely common in HIV-infected cohort of intravenous drug users with HCV co-infection which may die from liver cirrhosis or necrotizing liver failure (Guerra et al, 2001).…”

Section: Resultsmentioning

confidence: 99%