Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection

Kaiser Permanente Medical Center, Hayward, California, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 02/2003; 32(2):143-52. DOI: 10.1097/00126334-200302010-00005
Source: PubMed

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.

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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). "
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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"
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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). "
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