Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?

Lin, Yi‐Han; Garner, Sam; Lau, Jillian S.Y.; Korman, Tony M.; Woolley, Ian

doi:10.1093/qjmed/hcy223

Cited by 21 publications

(37 citation statements)

References 17 publications

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“…HIV IC are divided into three categories: those which are AIDS‐defining among persons living with HIV; conditions with an undiagnosed HIV prevalence of >0.1%; and conditions where not identifying HIV may have significant adverse implications for the individual's clinical management, despite the estimated prevalence of HIV being lower than 0.1% such as conditions requiring immune‐suppressive therapy (Table ) . In one large Australian‐based study, the most common IC present in patients with a late HIV diagnosis were unexplained weight loss, herpes zoster, thrombocytopenia or leukopenia, oral or oesophageal candidiasis and community‐acquired pneumonia …”

Section: Introductionmentioning

confidence: 99%

“…Routine testing for HIV in the presence of IC has been demonstrated to be cost effective . Failure to screen for HIV when patients intersect with the healthcare system with an IC represents a missed opportunity for earlier diagnosis . Other studies have demonstrated that among patients presenting with IC, rates of HIV testing are low .…”

Section: Introductionmentioning

confidence: 99%

“…Multiple barriers to testing have been identified including lack of knowledge of IC, lack of guidelines, low‐risk perception and perceived lack of knowledge around HIV . Studies reviewing non‐HIV specialty guidelines for IC found that many of these guidelines do not consider HIV testing as part of the investigations for IC . Thus, specialist clinicians managing IC may not be aware of the prevalence of undiagnosed HIV among their patients with such conditions.…”

Section: Introductionmentioning

confidence: 99%

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Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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Background In Australia, one‐third of human immunodeficiency virus (HIV) diagnoses occur late, with an estimated 11% of people with HIV unaware of their diagnosis. Undiagnosed and untreated HIV infection increases morbidity in the HIV positive person and allows onward transmission of HIV. Aim To determine the rate of HIV testing in acute general medicine patients with HIV indicator conditions (IC) and evaluate the effectiveness of an educational intervention in improving testing rates. Methods Single‐centre, tertiary hospital, before‐after study of general medicine inpatients with IC for 12 weeks prior and 10 weeks post an educational intervention focusing on recommendations for HIV testing including IC. The REASON Cohort Discovery Tool was used to search for the IC using ICD‐10 codes and laboratory data. The presence of IC was estimated, and HIV testing rates before and after the intervention were compared. Regression analysis was utilised to identify characteristics associated with HIV testing. Results Of 1414 admissions in the baseline period and 946 in the post‐period, 161 (11.4%) and 132 (14.0%) had at least one IC present respectively. There were 18 (11.2%) HIV tests performed for admissions with IC in the pre‐period which increased to 27 (20.5%) (P = 0.028) in the post‐period. Younger patients were more likely to be tested and regression analysis identified the educational intervention (adjusted odds ratio) 2.2 (1.1, 4.4) to be significantly associated with testing. Conclusions Although HIV testing rates for IC doubled following the intervention, they remained unacceptably low. The recently introduced electronic medical record presents opportunities to prompt HIV testing.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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“…With the roll out of pre‐exposure prophylaxis in Australia, it is likely as the number newly acquired HIV cases decline, late presenters will make up an increasing proportion of HIV diagnoses . We found in our institution, as mirrored in studies overseas, late presenters are more likely to be older, born overseas and report heterosexual sex as their exposure risk . To achieve earlier diagnosis of people living with HIV who do not identify themselves or are not recognised by clinicians to be at risk, different strategies need to be employed.…”

Section: Discussionmentioning

confidence: 59%

“…In our own experience and the experience of others, missed opportunities for diagnosis are likely to be followed by later presentation to hospital with AIDS‐defining events. Early diagnosis and screening are likely to reduce morbidity and mortality and be cost effective .…”

Section: Discussionmentioning

confidence: 88%

Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?

Lin

Eades

Nair

et al. 2020

Internal Medicine Journal

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Background Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition‐based testing, adapted from the European AIDS Clinical Society (EACS) guidelines. Aim To evaluate the extent that Australian non‐HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions. Methods EACS guidelines were reviewed to produce a list of 24 AIDS‐defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non‐diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study. Results Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty‐five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty‐five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing. Conclusions Although almost half of HIV non‐HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV.

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Current evidence on the adoption of indicator condition guided testing for HIV in western countries: A systematic review and meta-analysis

et al. 2021

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Background: Indicator condition (IC) guided testing for HIV is an effective way to identify undiagnosed people living with HIV, but studies suggest its implementation is lacking. This systematic review provides an overview of the adoption of IC-guided testing in Western countries. Methods: Seven ICs were selected: tuberculosis (TB), malignant lymphoma, hepatitis B, hepatitis C, cervical/ vulvar carcinoma/intraepithelial neoplasia grade 2+ (CC/CIN2+, VC/VIN2+), and peripheral neuropathy (PN). Embase and Ovid MEDLINE were searched up to November 20th, 2020. Publications of all types, using data from 2009, reporting on HIV test ratios in patients 18 years in all settings in Western countries were eligible. HIV test ratios and positivity were reported per IC. A random effects-model for proportions was used to calculate estimated proportions (ES) with 95% CIs. This study was registered at PROSPERO, registration number CRD42020160243. Findings: Fifty-seven references, including 23 full-text articles and 34 other publications were included. Most (28/57) reported on HIV testing in TB. No reports on HIV testing in VC/VIN2+ or PN patients were eligible for inclusion. Large variation in HIV test ratios was observed between and within ICs, resulting from different testing approaches. Highest HIV test ratios (pooled ratio: 0¢72, 95%CI 0¢63À0¢80) and positivity (0¢05, 95% CI 0¢03À0¢06) were observed among TB patients, and lowest among CC/CIN2+ patients (pooled ES test ratio: 0¢12, 95%CI 0¢01À0¢31, positivity: 0¢00, 95%CI 0¢00À0¢00). Interpretation: IC-guided HIV testing is insufficiently implemented in Western countries. The large variation in test ratios provides insight into priority areas for implementing routine IC-guided HIV testing in the future. Funding: HIV Transmission Elimination in Amsterdam (H-TEAM) consortium and Aidsfonds (grant number P-42,702).

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Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?

Cited by 21 publications

References 17 publications

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?

Current evidence on the adoption of indicator condition guided testing for HIV in western countries: A systematic review and meta-analysis

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