Abstract
Delayed diagnosis of HIV infection is associated with advanced immunosuppression and increased risk of onward transmission. Little data exists regarding factors associated with diagnostic delays among patients presenting with advanced HIV disease in China. Medical records of patients with HIV/AIDS hospitalized at a 2000-bed tertiary hospital in Beijing, China between 1997 and 2012 were retrospectively reviewed. Demographic and clinical data of patients newly diagnosed with HIV at the hospital were abstracted. Patient characteristics, disease parameters, and the time interval between the first medical visit and the visit leading to HIV diagnosis were compared among three periods: 1997–2002, 2003–2008 and 2009–2012. Chi-square, Kruskal-Wallis and logistic regression analyses were used as appropriate. A quarter of patients (72/279) were newly diagnosed with HIV at the hospital, consisting of 11, 29 and 32 patients in 1997–2002, 2003–2008 and 2009–2012 respectively. The median time delay between the first medical visit and the visit leading to HIV diagnosis decreased over time from 91 days among patients diagnosed before 2002, to 75 days between 2003 to 2008, and 39 days after 2009 (p = 0.036). However, the median CD4+T cell count at diagnosis was 26 cells/μL [interquartile range 3–132 cells/μL] in 1997–2002, and remained unchanged across time intervals. Forty-one (57%) patients had AIDS-defining conditions and Pneumocystis jiroveci pneumonia was the most common opportunistic infection (31 cases). These results reveal persistent missed opportunities for timely HIV testing among patients with advanced disease. Strategies for promoting early HIV testing in healthcare settings are needed in China.
Highlights
Delayed HIV diagnosis is associated with advanced immune compromise, increased risk of suboptimal responses to antiretroviral therapy (ART) [1], missed opportunities for preventing onward transmission and increased costs for the healthcare system [2,3,4]
The proportion of patients diagnosed in the Emergency Department increased from 0% in 1997–2002 to 24% in 2003–2008, and to 38% in 2009–2012
The median hospitalization time increased from 14 days in 1997–2002 to 29 days in 2009–2012. For those whom route of transmission was determined, blood-borne transmission was predominant in 1997–2002 (55%) and 2003–2008 (45%), whereas sexual transmission was most commonly reported in 2009–2012 (41%)
Summary
Delayed HIV diagnosis is associated with advanced immune compromise, increased risk of suboptimal responses to antiretroviral therapy (ART) [1], missed opportunities for preventing onward transmission and increased costs for the healthcare system [2,3,4]. There is consensus that early diagnosis of HIV infection and entry to care are essential for controlling HIV prevalence. A substantial proportion of HIV-infected individuals are still diagnosed at a late stage of disease worldwide. In the US, among persons aged 13 years and older, a quarter of infections were classified as having AIDS at the time of diagnosis [5]. In Europe, 54% of newly diagnosed HIV-infected individuals were late presenters as defined by having CD4+T cell counts below 350cells/μL or an AIDS-defining illness within six months of HIV diagnosis [6]. Identifying the factors associated with delayed diagnosis and attempting early testing is of great importance
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