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

  • Author Footnotes
    † Both authors contributed equally to this manuscript
    Lorena van den Bogaart
    Correspondence
    Corresponding author at: III Infectious Diseases Unit, ASST-FBF-Sacco, Via G.B. Grassi 74, Milano 20157, Italy.
    Footnotes
    † Both authors contributed equally to this manuscript
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Author Footnotes
    † Both authors contributed equally to this manuscript
    Alice Ranzani
    Footnotes
    † Both authors contributed equally to this manuscript
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Letizia Oreni
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
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  • Andrea Giacomelli
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Mario Corbellino
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Stefano Rusconi
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Massimo Galli
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Spinello Antinori
    Affiliations
    Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Anna Lisa Ridolfo
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Author Footnotes
    † Both authors contributed equally to this manuscript
Published:October 18, 2019DOI:https://doi.org/10.1016/j.ejim.2019.09.006

      Highlights

      • Late diagnoses of HIV infection negatively affect individual and public health.
      • A quarter of our LPs had been diagnosed with ≥1 HIV IC without being tested for HIV.
      • People aged >60 years were at highest risk of missing an earlier HIV diagnosis.
      • Missed HIV testing opportunities most frequently occurred in primary care setting.
      • IC-guided HIV testing should be implemented in non-specialist settings.

      Abstract

      Background

      Late diagnoses are still a cause of increased HIV-related morbidity and mortality despite the availability of highly effective treatments. The aim of this study was to identify indicator conditions (ICs) in late presenters with HIV infection (LPs) that may represent missed opportunities of undertaking earlier HIV testing.

      Methods

      The medical records of LPs referred to a specialist clinic in Milan, Italy, between 2011 and 2017 were reviewed to assess the frequency of ICs during the five years preceding diagnosis. Logistic regression analysis was used to investigate the factors associated with missed opportunities of making an earlier diagnosis.

      Results

      The analysis considered 203 LPs (60.6% of the patients newly diagnosed as having HIV infection during the study period). Most had had ≥1 medical encounter in the five years before diagnosis, and 54 (26.6%) had been diagnosed as having ≥1 IC without undergoing HIV testing. The most frequent ICs were herpes zoster (19.8%), constitutional symptoms (17.4%) and lympho/thrombocytopenia (12.8%), and the missed opportunities for testing occurred in the settings of primary care (44.9%), specialist medical (38.2%) or surgical services (11.3%), and emergency departments (5.6%). Twenty-five (53.2%) of the 47 subjects with a non AIDS-defining IC had AIDS at the time of the diagnosis of HIV infection. Subjects aged >60 years were at increased risk of missed diagnostic opportunities (aOR 4.80, p = 0.008).

      Conclusion

      Implementing IC-guided HIV testing in non-specialist settings is an essential means of reducing late diagnoses of HIV infection even in the case of older subjects.

      Keywords

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