Abstract
Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe.
Highlights
Of the estimated 2.3 million HIV infected individuals living in the European Region, it is estimated that one in three are unaware of their diagnosis [1,2,3]
Recruitment was by a call for expression of interest to more than 200 healthcare centres across Europe; healthcare settings were eligible for consideration if they handled one or more of the following eight conditions as part of their routine delivery of care: N Sexually transmitted infections (STI) N Malignant lymphoma, irrespective of type (LYM) N Cervical or anal cancer/dysplasia (CAN) N Herpes zoster (HZV) N Hepatitis B or C virus infection, acute or chronic, and irrespective of time of diagnosis relative to survey (HEP)
Indicator Condition-Guided HIV Testing recognition that these indicator conditions/diseases (ID) are related to HIV infection and occur more commonly in those infected, there are little data on previously undiagnosed HIV prevalence among individuals presenting with these conditions
Summary
Of the estimated 2.3 million HIV infected individuals living in the European Region, it is estimated that one in three are unaware of their diagnosis [1,2,3] Among those diagnosed with HIV, 50% have a CD4 count ,350 cells/uL at diagnosis, negatively impacting on both individual and public health [4,5]. A critical public health issue is, how to diagnose individuals with HIV infection at an earlier stage of disease. This will require the introduction of innovative approaches to better target testing for those most likely to be infected with HIV and who present late for care. The HIDES study (HIV Indicator Diseases across Europe Study) was subsequently designed by the HIV in Europe initiative (www. hiveurope.eu)
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