Overlooked cases of HIV infection: An Italian tale of missed diagnostic opportunities

Bogaart, Lorena van den; Ranzani, Alice; Oreni, Letizia; Giacomelli, Andrea; Corbellino, Mario; Rusconi, Stefano; Galli, Massimo; Antinori, Spinello; Ridolfo, Anna Lisa

doi:10.1016/j.ejim.2019.09.006

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…This phenomenon could have made the detection of new HIV diagnoses fail either because in their place of origin (usually small cities or villages throughout Italy) testing strategies could be sub-optimally implemented, or simply because diagnosis was made out of the network of our study. [ 6 ] Whatever are the reasons, our study has important implications for HIV testing strategies, suggesting that routine HIV testing should be promoted not only in the biggest cities (such as “Fast Track Cities for HIV”), but also in small centers, creating a more capillary screening network. As for risk factors, a statistically significant difference was found in the new diagnoses for MSM, with a significant lower percentage of MSM diagnosed in COVID-era than those diagnosed in pre-COVID era.…”

Section: Discussionmentioning

confidence: 99%

“…Also, due to restrictions, most Italian migrants moved from their workplace to their place of origin, for work-from-home strategies. This phenomenon could have made the detection of new HIV diagnoses fail either because in their place of origin (usually small cities or villages throughout Italy) testing strategies could be sub-optimally implemented, or simply because diagnosis was made out of the network of our study [6] . Whatever are the reasons, our study has important implications for HIV testing strategies, suggesting that routine HIV testing should be promoted not only in the biggest cities (such as “Fast Track Cities for HIV”), but also in small centers, creating a more capillary screening network.…”

Section: Discussionmentioning

confidence: 99%

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Has COVID-19 changed the approach to HIV diagnosis?

Mazzitelli

Ciccullo

Baldin³

et al. 2021

Medicine

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The occurrence of COVID-19 pandemic had a significant negative effect on health care systems over the last year. Health care providers were forced to focus mainly on COVID-19 patients, neglecting in many cases equally important diseases, both acute and chronic. Therefore, also screening and diagnostic strategies for HIV could have been significantly impaired.This retrospective, multicenter, observational study aimed at assessing the number and characteristics of new HIV/AIDS diagnoses during COVID-19 pandemic in Italy and compared characteristics of people living with HIV at diagnosis between pre-and post-COVID-19 era (2019 vs 2020).Our results showed a significant reduction of HIV diagnoses during pandemic. By contrast, people living with HIV during pandemic were older and were diagnosed in earlier stage of disease (considering CD4+ T cell count) compared to those who were diagnosed the year before. Moreover, there was a significant decrease of new HIV diagnoses among men who have sex with men, probably for the impact of social distancing and restriction applied by the Italian Government. Late presentation incidence, if numbers in 2020 were lower than those in 2019, is still an issue.Routinely performing HIV testing in patients with suspected SARS-CoV-2 infection is identifying and linking to care underdiagnosed people living with HIV earlier. Thus, combined tests (HIV and SARS-CoV-2) should be implemented in patients with SARS-CoV-2 symptoms overlapping HIV's ones. Lastly, our results lastly showed how urgent implementation of a national policy for HIV screening is necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Has COVID-19 changed the approach to HIV diagnosis?

Mazzitelli

Ciccullo

Baldin³

et al. 2021

Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Similar to our findings, a study from Morocco reported that 69% of their 650-subject cohort had missed opportunities for HIV testing 15 . In contrast, studies from countries outside the MENA region such as Italy, Sweden, Germany and UK showed that 21–27% of newly diagnosed HIV subjects who sought medical care for ICs were not offered HIV testing 46 – 50 . The missed opportunity proportion is higher in our cohort.…”

Section: Discussionmentioning

confidence: 94%

Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon

Mahmoud,

Ballouz,

Lahoud

et al. 2024

Sci Rep

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Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers’ attitudes and competencies.

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“…The trend remained constant over the entire period (Figure 1). The five most frequent MDOs were STIs (42), candidiasis (28), seborrhoeic dermatitis/exanthema (24), unjustified weight loss (19), and pneumonia (17). Breaking down the MDOs by the level of care, the two most frequent MDOs in the emergency department were pneumonia (12) and fever without apparent cause (9); in specialised care outpatient clinics, STIs (12) and seborrhoeic dermatitis/exanthema (9); and in primary care, STIs (27) and seborrhoeic dermatitis/exanthema (14) (Table 6).…”

Section: Resultsmentioning

confidence: 99%

Analysing Early Diagnosis Strategies for HIV Infection: A Retrospective Study of Missed Diagnostic Opportunities

Giménez-Arufe,

Rotea-Salvo,

Martínez-Pradeda

et al. 2024

Healthcare

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Early diagnosis of a Human Immunodeficiency Virus (HIV)-infected person represents a cornerstone of HIV prevention, treatment, and care. Numerous publications have developed recommendations where HIV serology is indicated to reduce missed diagnostic opportunities (MDOs). This retrospective study analyses new HIV infection diagnoses and the relationship between late diagnosis (LD)/advanced HIV disease (AHD), baseline characteristics, and MDOs. Sociodemographic data and data related to contact with the health system in the 5 years before diagnosis were collected. Most of the 273 diagnoses were made in primary care (48.5%). Approximately 50.5% and 34.4% had LD and AHD criteria, respectively. Female sex was associated with a higher incidence of LD. Persons infected through the heterosexual route and those at an older age had a higher risk for LD and AHD. People with previous HIV serology presented a lower percentage of LD and AHD. In total, 10% of the health contact instances were classified as MDOs, mostly occurring in primary care. A significant increase in the median of MDOs was observed in patients with LD/AHD. Female sex and hepatitis C virus co-infection were associated with an increase in the number of MDOs. The high percentage of LD and AHD and the significant number of MDOs show that the current screening system should be improved.

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Overlooked cases of HIV infection: An Italian tale of missed diagnostic opportunities

Cited by 9 publications

References 31 publications

Has COVID-19 changed the approach to HIV diagnosis?

Has COVID-19 changed the approach to HIV diagnosis?

Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon

Analysing Early Diagnosis Strategies for HIV Infection: A Retrospective Study of Missed Diagnostic Opportunities

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