Temporal trend and factors associated with late HIV diagnosis in Hong Kong, a low HIV prevalence locality.

Abstract

We studied the temporal trend of late HIV diagnosis and its determinants in Hong Kong. Three surrogate markers were used to proxy late diagnosis: AIDS within 3 months of HIV diagnosis, CD4 < 200/microL at HIV, and diagnosis at hospital. From 1984 to 2000, 1530 nonperinatal HIV infections and 495 patients with AIDS were reported. Overall, 23.9% to 52.1% of the patients were late presenters according to the three surrogates. There was no improvement in late diagnosis in the highly active antiretroviral therapy (HAART) era (1997-2000) compared to the pre-HAART era (1984-1996). Gender, ethnicity, age, and HIV exposure category were significant factors of late diagnosis on univariate analysis. On multivariate analysis, a lower risk of late diagnosis per all 3 surrogates was observed in men having sex with men (ranges of adjusted odds ratio [OR] [95% confidence interval [CI], 0.32-0.67 [0.21-0.91]) whereas the reverse was found for patients 35 years of age or older (ranges of adjusted ORs [95% CI], 1.62-2.80 [1.30-3.60]). In addition, male gender and Chinese ethnicity were associated with higher chance of having CD4 < 200/microL at HIV. The persistent trend of late HIV diagnosis in Hong Kong deserves attention. Strategies targeting infected people to enhance early HIV testing are needed, especially for those with risk factors of late diagnosis.