Abstract
ObjectivesThe primary objective was to examine trends in new HIV diagnoses in a UK area of high HIV prevalence between 2000 and 2012 with respect to site of diagnosis and stage of HIV infection.DesignSingle-centre observational cohort study.SettingAn outpatient HIV department in a secondary care UK hospital.Participants1359 HIV-infected adults.Main Outcome MeasuresDemographic information (age, gender, ethnicity, and sexual orientation), site of initial HIV diagnosis (Routine settings such as HIV/GUM clinics versus Non-Routine settings such as primary care and community venues), stage of HIV infection, CD4 count and seroconversion symptoms were collated for each participant.ResultsThere was a significant increase in the proportion of new HIV diagnoses made in Non-Routine settings (from 27.0% in 2000 to 58.8% in 2012; p<0.001). Overall there was a decrease in the rate of late diagnosis from 50.7% to 32.9% (p=0.001). Diagnosis of recent infection increased from 23.0% to 47.1% (p=0.001). Of those with recent infection, significantly more patients were likely to report symptoms consistent with a seroconversion illness over the 13 years (17.6% to 65.0%; p<0.001).ConclusionsThis is the first study, we believe, to demonstrate significant improvements in HIV diagnosis and a shift in diagnosis of HIV from HIV/GUM settings to primary practice and community settings due to multiple initiatives.
Highlights
There was a significant increase in the proportion of new human immunodeficiency virus (HIV) diagnoses made in Non-Routine settings
In 2011 there were an estimated 96,000 individuals in the UK infected with human immunodeficiency virus (HIV), of whom 24% were undiagnosed [1]. 47% of individuals were diagnosed late—with a CD4 count of less than 350 cells/mm3; such late diagnosis is associated with a significant increase in mortality [3]
It is increasingly recognised that older persons are a significant group affected by HIV: an increasing number of older individuals are acquiring HIV, older individuals have more rapid progression of HIV infection, and immunological response to antiretroviral therapy (ART) may be suboptimal [9]
Summary
In 2011 there were an estimated 96,000 individuals in the UK infected with human immunodeficiency virus (HIV), of whom 24% were undiagnosed [1]. 47% of individuals were diagnosed late—with a CD4 count of less than 350 cells/mm (the European consensus definition of late presentation [2]); such late diagnosis is associated with a significant increase in mortality [3]. 47% of individuals were diagnosed late—with a CD4 count of less than 350 cells/mm (the European consensus definition of late presentation [2]); such late diagnosis is associated with a significant increase in mortality [3]. Undiagnosed infection is associated with greater risk of onward transmission [4], and late diagnosis with increased healthcare costs [5]. In order to reduce rates of undiagnosed HIV, the UK and other countries have introduced multiple strategies to broaden HIV testing. Studies have shown that HIVinfected individuals who test late have often presented to healthcare facilities on multiple occasions within the last 2 years prior to their diagnosis, where the opportunity for a more timely diagnosis has been missed [8]. Current testing initiatives are less effective in reducing late diagnosis rates in such older persons [10]
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