Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?

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Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?

QJM. 2018 Oct 05;:

Authors: Lin YD, Garner SE, Lau JS, Korman TM, Woolley IJ

Abstract
Objective: To evaluate prevalence of HIV indicator conditions in late-presenters with HIV infection.
Design: Retrospective cohort study between 2000 and 2014.
Setting: Healthcare network in Melbourne, Australia.
Participants: Patients presenting with late diagnosis of HIV infection (CD4<350 cells/μL) compared to non-late presenting patients with HIV infection.
Intervention: The European AIDS Clinical Society (EACS) guidelines on HIV indicator guided testing were used to assess for any indicator conditions in their prior medical history which represented a missed opportunity for earlier diagnosis.
Main outcome measures: Descriptive statistics and prevalence of HIV indicator conditions.
Results: Of 436 patients with HIV infection, 82 were late presenters. Late presenters were more commonly male (83% vs 75%, p=0.11), older (mean age 45 vs 39 years), born overseas (61% vs 58%, p=0.68), and report heterosexual transmission as their exposure risk (51% vs 31%, p<0.001). Of 80 patients with late presentation of HIV infection, 54 (55%) had at least one, 29 (36%) at least two, 12 (15%) at least three and 5 (6%) had four or more previous HIV indicator conditions which would have triggered HIV testing according to guidelines. The most common indicator conditions were: unexplained loss of weight (31%), herpes zoster (10%), thrombocytopenia or leukopenia (10%), oral or oesophageal candidiasis (10%) and community acquired pneumonia (9%).Twenty-two patients (27.5%) had HIV indicator conditions diagnosed at least 12 months before the eventual diagnosis of HIV infection.
Conclusion: Patients diagnosed with late-presenting HIV often had an HIV indicator condition prior to presentation, presenting a missed opportunity for earlier diagnosis.

PMID: 30295832 [PubMed - as supplied by publisher]