Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection
ABSTRACT Early detection of HIV infection improves prognosis and reduces transmission, but 30%-40% of cases are diagnosed late. A comprehensive and systematic review of medical encounters before diagnosis has not been done. This study reviews 5 years of medical encounters before the diagnosis of HIV infection in members of a large managed care organization where access to care is reasonably good. Patient characteristics, HIV risk factors, and clinical events preceding diagnosis were examined and tested for association with late diagnosis (CD4 cell count of <200/microL at diagnosis). Of 440 HIV-infected patients, 62% had CD4 cell counts of <350/microL, 43% had CD4 cell counts of <200/microL, and 18% had CD4 cell counts of <50/microL at diagnosis. Twenty-six percent of all patients had risks documented >1 year before diagnosis. Only 22% of patients had one of eight clinical indicators suggested in the literature as reasons to test for HIV >1 year before diagnosis. In multiple logistic regression, older age, male sex, race, risk group, no prior HIV testing, physician-initiated testing, and having any of eight clinical indicators before diagnosis were each associated with late diagnosis (p <or=.05). Late diagnosis remains a challenge despite good access to care. In our setting, effective risk assessment before symptoms arise offers greater potential for raising the mean CD4 cell count at diagnosis than does increased awareness of selected HIV-associated clinical prompts.
- SourceAvailable from: Frederick Altice
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- "Many individuals with substance use disorders do not undergo HIV testing until they become clinically symptomatic and present with late-stage disease in hospitalized settings. Approximately 40% of HIV diagnoses are made after the disease has progressed to the point at which the person has advanced HIV infection, or acquired immune deficiency syndrome (AIDS) (Castilla et al. 2002; Dybul et al. 2002; Klein et al. 2003). As a result, symptomatic patients with substance use disorders or those who have health concerns may be more likely to undergo HIV testing than their asymptomatic counterparts (Anderson et al. 2005; Bond, Lauby & Batson 2005). "
ABSTRACT: Abstract Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07-3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11-0.88) and medical problems (AOR = 0.40, 95% CI = 0.17-0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.Journal of psychoactive drugs 07/2014; 46(3):208-214. DOI:10.1080/02791072.2014.915363 · 1.10 Impact Factor
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- "iradi et al . 2000 , Hocking et al . 2000 , Meredith et al . 2001 , Klein et al . 2003 ) , and health sector factors such as lack of insurance ( Turner et al . 2000 , Milberg et al . 2001 ) , not having a regular source of care ( Turner et al . 2000 ) , dislike of provider approaches ( Mallinson et al . 2007 ) or physician failure to assess risk ( Klein et al . 2003 ) . In Gabon , delays in seeking care have been attributed to a failure to seek biomedical care in favour of non - biomedical providers for early symptoms ( Okome - Nkoumou et al . 2005 ) . Lessells et al . ( 2011 ) note the importance of symptoms in leading to initiation of HIV care . In this article we report data from Uganda on delay"
ABSTRACT: Public health initiatives to 'test and treat' HIV-infected persons require understanding HIV care seeking. A study of 101 HIV-infected women receiving anti-retroviral medications in Kampala, Uganda, examined barriers to HIV care. Participants entered HIV/AIDS care late, despite knowing their risk and having sought care for symptoms. Over half of the participants (51%) reported delays of up to 5 years from when they suspected they were infected to seeking an HIV test. Some women reported that they did not perceive a need to be tested because they 'knew' they had HIV due to their partner's death from AIDS. Once tested, delays in entering HIV specific care ranged from less than 6 months to over 5 years. The most common reason reported for entering HIV care was the occurrence of serious or persistent symptoms. Late presentation for HIV care in this cohort is due to the inability of the medical system to link women to appropriate care. Women 'slip through the cracks' of this system, despite their care seeking behaviours. The inability to provide linkage to care is a challenge at the health system level that threatens the success of 'test and treat' protocols.Global Public Health 07/2012; 7(10). DOI:10.1080/17441692.2012.701318 · 0.92 Impact Factor
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- "For example, PBMC testing permits detection of intracellular expression of viral RNA rather than proviral DNA, which is particularly important when assessing viral transcriptional activity (Hatano et al., 2009; Deeks and Walker, 2007). Use of saliva as an alternative to blood or serum for HIV-1 RNA testing, may be useful at specimen collection sites where phlebotomy is not available, as well as in epidemiological studies for early transmission (Klein et al., 2003). Qualitative testing using seminal plasma is useful to determine presence or absence of sexual partner infectivity risk, as well as a screening method to monitor sperm washing techniques in instances where HIV-1 positive or serodiscordant couples are undergoing in vitro fertilization therapy (Coll et al., 1999). "
ABSTRACT: Peripheral blood mononuclear cells (PBMCs), saliva, seminal plasma, and dried blood spots were evaluated as specimen types for the APTIMA HIV-1 RNA Qualitative Assay (APTIMA HIV-1 Assay), which employs a target capture step to recover HIV-1-specific sequences from complex specimen types. Analytical sensitivity studies were carried out using samples that were either diluted or eluted with a buffered detergent and spiked with different concentrations of HIV-1 ranging from 1 to 10,000 copies/mL. PBMC samples spiked with HIV-1 had comparable analytical sensitivity to HIV-1 spiked plasma with a 95% limit of detection of 13.1 and 17.2 copies/mL, respectively. Analytical sensitivity in seminal plasma specimens diluted 1:5 and saliva diluted 1:2 was comparable to HIV-1 spiked dilution buffer alone. Whole blood and dried blood spot specimens spiked with HIV-1 had equivalent reactivity at 250 copies/spot (5000 copies/mL). However, the 95% limit of detection values were significantly different (293.7 copies/mL for whole blood and 2384 copies/mL for dried blood spot specimens). No significant effect on analytical sensitivity was observed when one HIV-1 positive dried blood spot punch was pooled with up to 9 HIV-1 negative dried blood spot punches. Together, these studies demonstrate that the APTIMA HIV-1 RNA Qualitative Assay can be used to process a diverse array of specimen types with minimal impact on analytical sensitivity for most specimen types.Journal of virological methods 08/2009; 159(1):10-4. DOI:10.1016/j.jviromet.2009.02.015 · 1.88 Impact Factor