Late diagnosis of HIV infection: missed diagnostic opportunities
DOI:
https://doi.org/10.23938/ASSN.0319Keywords:
HIV. Late diagnosis. Risk factors. Indicator disease. Epidemiology.Abstract
Background. To analyse the percentage of patients with a late diagnosis (LD) of HIV infection, their risk factors and the missed opportunities for an earlier diagnosis.
Methods. One hundred and sixty-five patients diagnosed with HIV infection in Navarre between 2009 and 2113 were included. Logistic regression was used to study the factors associated with LD (CD4 < 350 cells/mm3 or AIDS defining disease at diagnosis). The presence of risk factors and clinical indicators of possible HIV infection in the 5 years preceding the diagnosis were analyzed.
Results. The global prevalence of LD was 55% (90/165). This percentage was greater in immigrant patients than in Spanish patients, and in those without previous serology tests. An interaction was observed between the age and origin of patients. In Spaniards the risk of LD rose with age after 40 years (OR: 3.72; 95%CI: 1.52-9.12) but this did not occur in immigrant patients. Of the 132 patients who had received medical care in the years prior to diagnosis, 20 (15%) had classical risk factors recorded in their history, 14 (11%) proceeded from regions with a high prevalence of HIV, and 46 (35%) had presented clinical indicators (only 24 of them 1 year before diagnosis) without a serology test being realized.
Conclusions. In spite of multiple contacts with our health system, over half of the new cases of HIV infection are diagnosed late. Greater attention to clinical signs is needed and, above all, a better evaluation of the risk in asymptomatic patients.
Downloads
References
1. OLIVA J, GALINDO S, VIVES N, ARRILLAGA A, IZQUIERDO A, NICOLAU A et al. Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España. Enferm Infecc Microbiol Clin 2010; 28: 583-589.
https://doi.org/10.1016/j.eimc.2010.02.013
2. DE OLALLA PG, MANZARDO C, SAMBEAT MA, OCAÑA I, KNOBEL H, HUMET V et al. Epidemiological caracteristics and predictors of late presentation of hiv infection in Barcelona (Spain) during the period 2001-2009. AIDS Res Ther 2011; 8: 22.
https://doi.org/10.1186/1742-6405-8-22
3. VIVES N, CARNICER-PONT D, GARCÍA DE OLALLA P, CAMPS N, ESTEVE A, CASANOBA J. Factors associated with late presentation of hiv infection in Catalonia, Spain. Int J STD AIDS 2012; 23: 475-480.
https://doi.org/10.1258/ijsa.2011.011280
4. OLIVA J, DÍEZ M, GALINDO S, CEVALLOS C, IZQUIERDO A, CEREIJO J et al. Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain. Gac Sanit 2014; 28: 116-122.
https://doi.org/10.1016/j.gaceta.2013.06.009
5. ANTINORI A, COENEN T, COSTAGIOLA D, DEDES N, ELLEFSON M, GATELL J et al. Late presentation of hiv infection: a consensus definition. Hiv Med 2011; 12: 61-64.
https://doi.org/10.1111/j.1468-1293.2010.00857.x
6. CASTILLA J, SOBRINO P, DE LA FUENTE L, NOGUER I, GUERRA L, PARRAS F. Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. AIDS 2002; 16:1945-1951.
https://doi.org/10.1097/00002030-200209270-00012
7. COHEN MS, CHEN YQ, MCCAULEY M, GAMBLE T, HOSSEINIPOUR MC, KUMARASAMY N et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365: 493-505.
https://doi.org/10.1056/NEJMoa1105243
8. GAZZARD B, CLUMECK N, D'ARMINIO MONFORTE A, LUNDGREN JD. Indicator disease-guided testing for HIV--the next step for Europe? HIV Med 2008; 9: S34-S40.
https://doi.org/10.1111/j.1468-1293.2008.00592.x
9. HIV en Europe initiative, HIV indicator conditions: guidance for implementing HIV testing in adults in health care settings. Disponible en: HTTP://hiveurope.eu (Fecha de consulta el 15 de enero de 2014)
10. AIDSInfo. Base de datos de AIDSInfo, ONUSIDA, 2012. Disponible en: http://www.unaids.org/en/dataanalysis/datatools/aidsinfo (Fecha de consulta el 15 de enero de 2014)
11. LODI S, PHILLIPS A, TOULOUMI G, GESKUS R, MEYER L, THIÉBAUT R et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis 2011; 53: 817-825.
https://doi.org/10.1093/cid/cir494
12. MOCROFT A, LUNDGREN JD, SABIN ML, MONFORTE AD, BROCKMEYER N, CASANOBA J et al. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLOS MED 2013; 10: E1001510.
https://doi.org/10.1371/journal.pmed.1001510
13. SCOGNAMIGLIO P, CHIARADIA G, DE CARLI G, GIULIANI M, MASTROIANNI CM, AVIANI BARBACCI S et al. The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis. BMC Infect Dis 2013; 13: 473.
https://doi.org/10.1186/1471-2334-13-473
14. CASTILLA J, LORENZO JM, IZQUIERDO A, LEZAUN ME, LÓPEZ I, MORENO-IRIBAS C et al. Characteristics and trends of newly diagnosed HIV-infections, 2000-2004. Gac Sanit 2006; 20: 442-448.
https://doi.org/10.1157/13096525
15. BLANCO JR, CARO AM, PÉREZ-CACHAFEIRO S, GUTIÉRREZ F, IRIBARREN JA, GONZÁLEZ-GARCÍA J et al. HIV infection and aging. AIDS Rev 2010; 12: 218-230.
16. BRANSON BM, HANDSFIELD HH, LAMPE MA, JANSSEN RS, TAYLOR AW, LYSS SB et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55 (RR-14): 1-17.
17. KLEIN D, HURLEY LB, MERRILL D, QUESENBERRY CP JR. Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection: implications for early detection. J Acquir Immune Defic Syndr 2003; 32: 143-152.
https://doi.org/10.1097/00126334-200302010-00005
18. JENKINS TC, GARDNER EM, THRUN MW, COHN DL, BURMAN WJ. Risk-based human immunodeficiency virus (HIV) testing fails to detect the majority of HIV-infected persons in medical care Settings. Sex Transm Dis 2006; 33: 329-333.
https://doi.org/10.1097/01.olq.0000194617.91454.3f
19. DUFFUS WA, WEIS K, KETTINGER L, STEPHENS T, ALBRECHT H, GIBSON JJ. Risk-based HIV testing in South Carolina health care settings failed to identify the majority of infected individuals. AIDS Patient Care STDS 2009; 23: 339-345.
https://doi.org/10.1089/apc.2008.0193
20. SULLIVAN AK, RABEN D, REEKIE J, RAYMENT M, MOCROFT A, ESSER S et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PloS One 2013; 8: e52845.
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
