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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Article info
Publication history
Published online: October 18, 2019
Accepted:
September 12,
2019
Received in revised form:
September 6,
2019
Received:
July 6,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
