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Late Diagnosis of HIV Infection: The Role of Age and Sex

These data were presented in part at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil July 25-28, 2005.
https://doi.org/10.1016/j.amjmed.2006.05.050Get rights and content

Abstract

Background

Late diagnosis of human immunodeficiency virus (HIV) infection is detrimental to infected persons and to the public health. The objective of this study was to identify factors associated with late diagnosis of HIV infection, defined as an initial CD4 count <200 cells/μL, in a cohort of recently diagnosed persons. Additionally, we evaluated factors associated with HIV infection being diagnosed during hospitalization.

Methods

This was a cross-sectional study of a university-based HIV clinic in the southeastern US. Patients with newly diagnosed HIV infection evaluated at the Duke University HIV clinic between October 2002 and August 2004 were included in this analysis. Socio-demographic variables, site of HIV diagnosis, opportunistic infections present at diagnosis, initial CD4 count, and initial HIV RNA level were recorded for study subjects.

Results

Forty-nine percent of subjects met the immunologic definition of AIDS at the time of HIV diagnosis (CD4 count <200 cells/μL). In multivariable logistic regression analyses, older patients were more likely to be diagnosed with a CD4 count <200 cells/μL (adjusted odds ratio [AOR] 1.72, 95% confidence interval [CI], 1.12-2.64, P = .01), and older patients (AOR 1.79, 95% CI, 1.07-3.12, P = .03) and women (AOR 6.74, 95% CI, 2.08-21.81, P = 0.001) were more likely to be diagnosed during hospitalization.

Conclusions

Late diagnosis of HIV infection is a considerable problem, particularly for older patients. Inpatient diagnosis of HIV infection is significantly more common among women and older patients. Improved HIV testing strategies may allow for more timely diagnosis of HIV infection, which may benefit both the infected individual and society.

Section snippets

Study Design

We evaluated medical records of clinic patients initially presenting for care at the Duke University HIV clinic between October 2002 and August 2004. Persons whose HIV infection had been diagnosed within 6 months of presentation to the clinic were included in this analysis. Abstracted data included socio-demographic and clinical information. Non-Caucasians were classified as racial/ethnic minorities. Consistent with the CDC classification, persons not residing in a metropolitan statistical area

Results

Data were available for 113 patients who met study inclusion criteria (Table 1). Initial CD4 counts were <200 cells/μL in 49% of subjects, and 35% were diagnosed during hospitalization.

Discussion

Despite efforts to increase HIV prevention and awareness, half the recently diagnosed HIV-infected patients evaluated at a university-based HIV clinic in North Carolina had initial CD4 counts <200 cells/μL, compared with only 12% of those reported a decade earlier from South Carolina.8 This may relate to changes in socio-demographic characteristics among persons living with HIV/AIDS, such that persons now at greatest risk are less likely to be tested due to issues of stigma and lower perceived

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Supported by Agency for Healthcare Research and Quality (AHRQ) training Grant T32 HS000079 and NIH K24 Grant NIAID 5 K24 AI001608.

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