Late Human Immunodeficiency Virus Diagnosis Research Articles

A case of fatal monkeypox infection: necropsy and molecular findings, with some considerations related to clinical management

ObjectiveHuman monkeypox (mpox) is usually self-limited infection; however, rising data show a worse outcome in patients with impaired immune status, particularly those co-infected with HIV [Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS et al. Mpox in people with advanced HIV infection: A global case series. Lancet. 2023; 401:939–49. DOI:https://doi.org/10.1016/S0140-6736(23)00273-8] [Govind A, Lazarte SM, Kitchell E, Chow JY, Estelle CD, Fixsen E et al. Severe mpox infections in people with uncontrolled human immunodeficiency virus (HIV). Clin Infect Dis. 2023; 76:1843–6. DOI:https://doi.org/10.1093/cid/ciad052]. MethodsWe report the clinical, pathological, and molecular study of a patient with mpox infection and a late HIV diagnosis, with fatal outcome. ResultsNecropsy revealed visceral spread of mpox. Mpox virus was sequenced twice during the admission, uncovering an emerging mutation near a genomic region where mutations associated with tecovirimat resistance have been documented. DiscussionMonkeypox can manifest as an opportunistic infection in individuals with advanced HIV-associated immunosuppression.

Comparison between patients who interrupted ART and those with late HIV diagnosis

ABSTRACT Early diagnosis of human immunodeficiency virus (HIV) and retention in care are cornerstones of better prognosis of people living with HIV (PLWH). The purpose of this study was to compare patients who discontinued antiretroviral treatment (ART) with those who were diagnosed late with HIV. In this retrospective analysis of PLWH under the care of one of the Infectious Diseases Clinics in Poland between 2020 and 2021, two sub-analyses were carried out. One comparing patients who relinked to care after treatment interruption (“Group A”) with those who had late HIV diagnosis (“Group B”), another comparing group A to those who were adherent to ART (“Group C”). 215 patients were included in this study (Group A = 47, Group B = 53, Group C = 115). Those who discontinued ART more often used actively drugs (p = 0.001) in comparison to those with late HIV diagnosis. In both bivariate and multivariable analysis migrants were more often diagnosed late with HIV than interrupted ART (p = 0.004 and 0.015, respectively). In the second analysis, in the multivariable analysis female sex was not associated with treatment interruption, whereas active drug usage was. People using drugs have a higher risk of ART interruption. Migrants are more at risk of late HIV diagnosis. Adequate interventions should be made towards both groups.

Association of demographics, HCV co-infection, HIV-1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV-1 Surveillance Network.

Late diagnosis of the human immunodeficiency virus (HIV) is a major concern epidemiologically, socially and for national healthcare systems. Although the association of certain demographics with late HIV diagnosis has been reported in several studies, the association of other factors, including clinical and phylogenetic factors, remains unclear. In the present study, we conducted a nationwide analysis to explore the association of demographics, clinical factors, HIV-1 subtypes/circulating recombinant form (CRFs) and genetic clustering with late HIV diagnosis in Japan, where new infections mainly occur among young men who have sex with men (MSM) in urban areas. Anonymized data on demographics, clinical factors and HIV genetic sequences from 39.8% of people newly diagnosed with HIV in Japan were collected by the Japanese Drug Resistance HIV-1 Surveillance Network from 2003 to 2019. Factors associated with late HIV diagnosis (defined as HIV diagnosis with a CD4 count <350 cells/μl) were identified using logistic regression. Clusters were identified by HIV-TRACE with a genetic distance threshold of 1.5%. Of the 9422 people newly diagnosed with HIV enrolled in the surveillance network between 2003 and 2019, 7752 individuals with available CD4 count at diagnosis were included. Late HIV diagnosis was observed in 5522 (71.2%) participants. The overall median CD4 count at diagnosis was 221 (IQR: 62-373) cells/μl. Variables independently associated with late HIV diagnosis included age (adjusted odds ratio [aOR] 2.21, 95% CI 1.88-2.59, ≥45 vs. ≤29 years), heterosexual transmission (aOR 1.34, 95% CI 1.11-1.62, vs. MSM), living outside of Tokyo (aOR 1.18, 95% CI 1.05-1.32), hepatitis C virus (HCV) co-infection (aOR 1.42, 95% CI 1.01-1.98) and not belonging to a cluster (aOR 1.30, 95% CI 1.12-1.51). CRF07_BC (aOR 0.34, 95% CI 0.18-0.65, vs. subtype B) was negatively associated with late HIV diagnosis. In addition to demographic factors, HCV co-infection, HIV-1 subtypes/CRFs and not belonging to a cluster were independently associated with late HIV diagnosis in Japan. These results imply the need for public health programmes aimed at the general population, including but not limited to key populations, to encourage HIV testing.

The Negative Impact of COVID-19 in HCV, HIV, and HPV Surveillance Programs During the Different Pandemic Waves.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been a worldwide stress test for health systems. 2 years have elapsed since the description of the first cases of pneumonia of unknown origin. This study quantifies the impact of COVID-19 in the screening program of chronic viral infections such as human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) along the six different pandemic waves in our population. Each wave had particular epidemiological, biological, or clinical patterns.MethodsWe analyzed the number of samples for screening of these viruses from March 2020 to February 2022, the new infections detected in the pandemic period compared to the previous year, the time elapsed between diagnosis and linking to treatment and follow-up of patients, and the percentage of late HIV diagnosis. Moreover, we used the origin of the samples as a marker for quantifying the restoration of activity in primary care.ResultsDuring the first pandemic year, the number of samples received was reduced by 26.7, 22.6, and 22.5% for molecular detection of HPV or serological HCV and HIV status respectively. The highest decrease was observed during the first wave with 70, 40, and 26.7% for HPV, HCV, and HIV. As expected, new diagnoses also decreased by 35.4, 58.2, and 40.5% for HPV, HCV, and HIV respectively during the first year of the pandemic. In the second year of the pandemic, the number of samples remained below pre-pandemic period levels for HCV (−3.6%) and HIV (−9.3%) but was slightly higher for HPV (8.0%). The new diagnoses in the second year of the pandemic were −16.1, −46.8, and −18.6% for HPV, HCV, and HIV respectively.ConclusionsUndoubtedly, an important number of new HPV, HCV, and HIV infections were lost during the COVID-19 pandemic, and surveillance programs were disrupted as a consequence of collapse of the health system. It is a priority to reinforce these surveillance programs as soon as possible in order to detect undiagnosed cases before the associated morbidity-mortality increases. New pandemic waves could increase the risk of reversing the achievements made over the last few decades.

Assessing the effectiveness of prevention of mother-to-child HIV transmission

Aim. To analyze the outcomes of a set of interventions to prevent vertical transmission of the human immunodeficiency virus (HIV) in the Republic of Mari El.&#x0D; Methods. A retrospective analysis of temporary registration forms Notifications of the termination of pregnancy in an HIV-infected woman and Notifications of a newborn born by an HIV-infected mother, case histories and outpatient medical records of HIV-infected women who gave birth in 20002018 was carried out. The study included all children born in the Republic of Mari El to HIV-positive women registered with the Republican Center for the Prevention and Control of AIDS and Infectious Diseases, as well as children whose HIV status is detected after birth as a result of epidemiological investigations. The assessment of the risks of transmission as an outcome of the three-step preventive interventions has been carried out. A comparative analysis of the results of perinatal prevention of HIV transmission in the Republic of Mari El and other regions of the Russian Federation was performed.&#x0D; Results. A total of 299 HIV-infected pregnant women and 368 children born to these women during the study period were registered in the region; 63 (21.7%) of these women had more than one child. Over the entire study period, 18 (4.8%) children with confirmed HIV infection were registered. The most common factor associated with infant HIV infection is late maternal HIV diagnosis: (1) several years after childbirth in the absence of antiretroviral (ARV) prophylaxis and the infants were breastfeeding (11 cases, 64.7%); (2) during or shortly after childbirth, when the patient did not receive entire three-step antiretroviral prophylaxis during pregnancy and childbirth (6 cases, 29.4%); (3) in the third trimester of pregnancy (1 case, 5.5%). An important limitation for the successful prevention of vertical transmission of HIV was the lack of routine HIV testing, which is required by women and their partners before and at various stages during pregnancy. A single case of self-infection indicates the need to introduce preventive measures from early adolescence among children.&#x0D; Conclusion. Due to the late maternal HIV diagnosis, during or after delivery, HIV transmission events occurred either with limited or no limited antiretroviral prophylaxis.

Review on the Alteration of Gut Microbiota: The Role of HIV Infection and Old Age.

Human immunodeficiency virus (HIV) infection results in gut microbiota alteration and this is associated with immune activation and chronic inflammation. The gastrointestinal tract is a primary site of viral replication and thus HIV-induced loss of T-helper (Th) cells in the gut causes impairments in intestinal barriers, resulting in disruptions in intestinal immunity and precipitating into gut dysbiosis. Here, we show that late HIV diagnosis can negatively affect the immunological, virological, and clinical prognosis of the patients with its higher implication at an older age. Further, the review indicates that antiretroviral therapy affects the gut microbiota. We discussed the use of probiotics and prebiotics that have been indicated to play a promising role in reversing gut microbiota alteration in HIV patients. Though there are several studies reported with regard to such alterations in gut microbiota regarding HIV infection, there is a need to provide comprehensive updates. It is, therefore, the objective of this review to present most recently available evidence on the alteration of gut microbiota among HIV patients.

Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study.

Achieving the Joint United Nations Program on human immunodeficiency virus (HIV)/AIDS Fast-Track targets requires additional strategies for mobile populations. We examined trends and socio-demographics of migrants (overseas-born) and Australian-born individuals presenting with late and advanced HIV diagnoses between 2008 and 2017 to help inform public health approaches for HIV testing coverage and linkage to care and treatment.We conducted a retrospective population-level observational study of individuals diagnosed with HIV in Australia and reported to the National HIV Registry. Annual proportional trends in late (CD4+ T-cell count <350 cells/μL) and advanced (CD4+ T-cell count <200 cells/μL). HIV diagnoses were determined using Poisson regression.Of 9926 new HIV diagnoses from 2008 to 2017, 84% (n = 8340) were included in analysis. Overall, 39% (n = 3267) of diagnoses were classified as late; 52% (n = 1688) of late diagnoses were advanced. Of 3317 diagnoses among migrants, 47% were late, versus 34% of Australian-born diagnoses (P < .001).The annual proportions of late (incidence rate ratio [IRR] 1.00; 95% confidence interval [CI] 0.99–1.01) and advanced HIV diagnoses (IRR 1.01; 95% CI 0.99–1.02) remained constant. Among migrants with late HIV diagnosis, the proportion reporting male-to-male sex exposure (IRR 1.05; 95% CI 1.03–1.08), non-English speaking (IRR 1.03; 95% CI 1.01–1.05), and individuals born in countries in low HIV-prevalence (IRR 1.02; 95% CI 1.00–1.04) increased. However, declines were noted among some migrants’ categories such as females, heterosexual exposure, English speaking, and those born in high HIV-prevalence countries.Late HIV diagnosis remains a significant public health concern in Australia. Small declines in late diagnosis among some migrant categories are offset by increases among male-to-male exposures. Reaching the Fast-Track targets in Australia will require targeted testing and linkage to care strategies for all migrant populations, especially men who have sex with men.

Late HIV diagnosis and missed opportunities for testing: piloting a standardised, multi-source review process.

Late diagnosis of human immunodeficiency virus (HIV) (CD4 &lt; 350) remains common in the UK and missed opportunities (MOs) for testing are often evident. National guidelines recommend HIV clinics conduct look-back reviews in all patients presenting late; however, a standardised methodology is not available and reviews are not routinely performed. This multi-centre audit reviewed all new, late HIV diagnoses across three centres in North East England. A standardised review process (incorporating a shared regional pathology system and summary care records) was used to identify MOs. Of 45 late diagnoses reviewed (median age 45 years, 76% male, median CD4 cell count 134), 28 (62%) had one or more MO, with a median of 18 months from MO to presentation. Sixty-two per cent of MOs occurred in primary care and most (82%) consisted of indicator conditions. At HIV presentation, 27 (60%) suffered moderate harm, 16 (36%) presented with acquired immune deficiency syndrome (AIDS) and 10 (22%) suffered severe harm, including 3 (7%) who died. Despite challenges in eliciting full medical records, the comprehensive review process described, which incorporates two regional electronic records, was more effective than previous methodologies and identified more MOs. Many people present with late HIV infection or AIDS and increased efforts are needed to improve testing.

574. Late Diagnosis of HIV in South Carolina: Prevalence, Cause, and Consequences

BackgroundLate diagnosis of human immunodeficiency virus (HIV) increases the risk of new transmission, acquired immune deficiency syndrome (AIDS), and AIDS-related deaths. Late HIV diagnosis is also thought as a major impediment for the success of antiretroviral therapy (ART) outcomes. In the United States in 2014, about one-quarter of HIV infections were diagnosed late and simultaneously with AIDS. South Carolina (SC), a rural southern state, is among the nation’s top in HIV incidence and also exhibits a very high rate of late HIV diagnosis. This study investigates prevalence, causes, and consequences of late HIV diagnosis in SC.MethodsUsing statewide surveillance data from patients diagnosed with HIV in the period 1997–2013, late diagnosis of HIV infection was defined as Stage 3 (AIDS) based on CD4 count 200 cells/mL and/or opportunistic illness within 3 months of HIV diagnosis. Logistic regression approach is used to identify the patient groups susceptible to late diagnosis. A Bayesian joint analysis is used to model the differentials in viral load, CD4 cell count, and death risk as consequences of late diagnosis. All statistical analyses have been performed after controlling for patient demographics and treatment information and statistical significance were reported at 5% level.ResultsThe proportion of late HIV diagnosis declined from 61.6% in 1997 to 38.7% in 2013. However, the rate of late diagnosis in SC is still alarming and higher than many other states in the country. Male, non-White, and older patients exhibited higher odds of late diagnosis. After adjusting for demographic and treatment characteristics, the joint model analysis revealed that the patients diagnosed late were able to maintain lower viral loads even when compared with early diagnosed patients. However, late diagnosis made them highly vulnerable to have poor CD4 count and put them at about 70% high risk of death.ConclusionFrom early diagnosis of HIV infection, both the patient and the society can be benefited. The findings from this study can help devising policy strategies to implement targeted intervention and spread awareness to reduce late diagnosis after HIV infection in SC.Disclosures All authors: No reported disclosures.

Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis.

BackgroundLate presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care.MethodsQuantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome: ‘late HIV testing’, ‘late HIV diagnosis’ and ‘late presentation for HIV care after testing’. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta- analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value.ResultsTen studies from low- and middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6–3.6, I2 = 79%).ConclusionsHigh perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should play a key role in informing and counselling patients on the benefits of early HIV testing or early entry to HIV care. Additionally, linking the systems and positive case tracing after HIV testing should be strengthened.

The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999–2013

ObjectivesDespite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy. Study designWe conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS – acquired immune deficiency syndrome) for the years 1999–2013. MethodsLate testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time. ResultsAmong 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38–2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12–1.37 and OR = 1.51, 95% CI: 1.38–1.67, respectively) vs PWA aged 35–49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06–14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30–9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006–2013 = 5.3, 95% CI: 3.8–6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18–34 years (APC = 5.3, 95% CI: 4.5–6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7–17.5). ConclusionsThe increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.

Factors associated with late Human Immunodeficiency Virus (HIV) diagnosis among peoples living with it, Northwest Ethiopia: hospital based unmatched case-control study

BackgroundEarly HIV diagnosis and access to treatment is one of the most effective ways to prevent its further spread and to protect the health of those living with the virus. However, delay in diagnosis is the major risk factor for uptake of and response to antiretroviral therapy.MethodsInstitution-based unmatched case-control study design was used in the study. The study was conducted in Debre-Markos and Finote-Selam Hospitals, Northwest Ethiopia. Cases were people living with HIV who had CD4 count <350cells/mm3 or WHO clinical stage III and IV regardless of the CD4 count at first presentation and controls were those who had CD4 count ≥350cells/mm3 or WHO clinical stage I and II. If both criteria were available, the CD4 count was used in the study as World Health Organization recommended. A total of 392 respondents (196 cases and 196 controls) were recruited and selected systematically. The data were collected by trained nurses using chart review and interviewer administered structured questionnaire. Binary Logistic Regression Model was used to identify the factors associated with late HIV diagnosis.ResultsAbout 95.9 % of study participants provided complete response. Having no understanding, compared to having understanding, about HIV/AIDS (AOR = 1.7, 95 %CI = 1.08–2.79) and ART (AOR = 2.1, 95 %CI: 1.25–3.72), being tested as a result of symptoms/ illness, compared to being tested for risk exposure (inverted AOR =2.5, 95 %CI: 1.64–4.76), and acquiring HIV through sexual contact, compared to acquiring it through other modes (AOR = 2.5, 95 %CI = 1.52–4.76) were positively and independently associated with late HIV diagnosis.ConclusionsUnlike perceived HIV stigma, having no understanding about HIV and ART, being tested for presence of symptoms/illness, and acquiring HIV through sexual contact were independent and significant factors for late HIV diagnosis.

Tuberculosis Treatment Outcomes of Patients Co-Infected With Tuberculosis And HIV At Jaramogi Oginga Odinga Teaching And Referral Hospital (JOOTRH), Kenya.

Background:Human Immunodeficiency Virus (HIV) infection and Tuberculosis (TB) increase the rate of disease progression of each other, thereby reducing the survival time of the patients. TB disease is considered a preventable, detectable and curable disease that requires wider public- private partnerships. Causes of mortality include late TB and/or HIV diagnosis, late HAART initiation, overlapping drug toxicities or comorbidities, drug-drug interactions between rifamycin and antiretroviral drugs, and immune reconstitution syndrome of TB after ART initiation etc. The Kenya National TB cohort analysis showed poorer treatment outcomes to be higher among patients with unknown or undocumented HIV status followed by HIV positive TB patients. Nyanza province contributes TB(20%) and HIV (30%) burden of the national burden, with coinfection rate of 70% of TB patients against 53% national rate. Early diagnosis, treatment initiation and monitoring leads to improved survival. Methods: This was a retrospective study aimed at evaluating socio-demographic characteristics of 350 TB/HIV co-infected patients (adults and children) enrolled in JOOTRH and documented treatment outcomes, risk factors associated with mortality and lost to follow up between January 2012 and July 3013 who were followed up 8 months after completion of treatment. Conclusion:Early ART initiation in the intensive phase of TB treatment, use of Cotrimoxazole, being WHO stage I & II and CD4> 350cells/mm 3 were associated with reduced deaths or loss to follow up while being male gender, initiating or delaying treatment after 2 months of TB treatment, WHO stage III and IV and CD4 < 350cells/mm 3 were significantly associated with high mortality.

Late HIV Diagnosis: Proposed Common Definitions and Associations With Short-Term Mortality.

The aim of this study was to present a definition of late presentation according to different time periods between initial diagnosis of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) diagnosis which would reliably identify individuals with high risk of mortality within 1 year of diagnosis, and could be used as a suggested common definition.Data of individuals diagnosed from 1994 to February 2012 in Wuhan, China were extracted retrospectively from the national HIV surveillance system. Four time periods (1, 3, 6, and 12 months) combined with the European consensus definition of advanced HIV disease (AHD) were compared. The predictive ability of each definition for identifying an individual who died within 1 year after HIV diagnosis was assessed.A total of 980 patients were included, of whom 289 (29.49%), 324 (33.06%), 353 (36.02%), and 387 (39.49%) were defined as AHD according to the definition of a CD4 count <200 cells/μL or AIDS-defining event (ADE) within 1, 3, 6, and 12 months of HIV diagnosis, respectively. One hundred twenty-seven (12.96%) patients died within 1 year of diagnosis. The highest Youden's index and largest area under the curve were presented in time period within 3 months. Time period within 1 month presented the highest consistency rate, positive likelihood ratio, and kappa value. Longer time periods increased the sensitivity but decreased the specificity.Given the European consensus definitions and the current results, we suggested that AHD could be defined as “a first-reported CD4 count <200 cells/μL or an ADE within 1 month after HIV diagnosis.” “Late presentation” could be defined as “a first-reported CD4 count <350 cells/μL or an ADE within 1 month after HIV diagnosis.”

Prevalence of and risk factors for late diagnosis of HIV infection in Brazilian infants and children.

Late human immunodeficiency virus (HIV) diagnosis is an important cause of HIV-related morbidity and mortality in infants and children. This retrospective cohort study of HIV-infected children diagnosed in Sergipe, in northeastern Brazil, between 2002 and 2011 aimed to determine the prevalence of and risk factors for late HIV diagnosis. Of 55 infants and children with confirmed infection, 42 (76.5%) were diagnosed at ≥ 12 months old. No antiretroviral prophylaxis during delivery (OR 5.48, 95% CI 1.11-32.34) was associated with late diagnosis. More than 75% of cases were diagnosed late. Efforts are needed to improve early HIV diagnosis in infants.

HIV in young people: characteristics and predictors for late diagnosis of HIV

Late diagnosis of human immunodeficiency virus (HIV) infection remains a challenging issue, especially in young population, which accounts for approximately half of new HIV infections. This study aimed to assess factors associated with late diagnosis of HIV infection in young people. It employed a hospital-based case-control design, conducted during January 2012 through August 2013. A total of 193 patients aged 18–25 years old from 21 hospitals across Thailand were studied. Late diagnosis was defined as presentation when the CD4 cell count was less than 350 cells/µL within 12 months of the first HIV diagnosis, or AIDS-defining event is present within 12 months of the first HIV diagnosis. Factors associated with the late diagnosis of HIV were those who: did not live with their parent (OR 3.87; 95% CI 1.40–10.66), had no children (OR 3.25; 95% CI 1.27–8.31), had their first sexual intercourse at age older than 18 years (OR 4.25; 95% CI 1.27–14.22), had same-age or older partners (OR 3.36; 95% CI 1.39–8.08), were substance users (OR 3.65; 95% CI 1.22–10.88), believed they changed their behaviors after receiving HIV education (OR 2.48; 95% CI 1.02–5.99), and sought care at regional (OR 3.19; 95% 1.31–7.79) or general hospitals (OR 3.34; 95% 1.07–10.35). Strategies for early HIV detection in young people should be reconsidered; particularly the involvement of parents and targeting the right population.

HIV infection in patients with intraocular inflammation

HIV infection in patients with intraocular inflammation

Do people with HIV infection have a normal life expectancy in the era of combination antiretroviral therapy?

There is evidence that the life expectancy (LE) of individuals infected with the human immunodeficiency virus (HIV) has increased since the introduction of combination antiretroviral therapy (cART). However, mortality rates in recent years in HIV-positive individuals appear to have remained higher than would be expected based on rates seen in the general population. A low CD4 count, whether due to late HIV diagnosis, late initiation of cART, or incomplete adherence to cART, remains the dominant predictor of LE, and thus the individual’s disease stage at initiation of cART (or thereafter) certainly contributes to these higher mortality rates. However, individuals with HIV also tend to exhibit lifestyles and behaviors that place them at increased risk of mortality, particularly from non-AIDS causes. Thus, although mortality rates among the HIV population may indeed remain slightly higher than those seen in the general population, they may be no higher than those seen in a more appropriately matched control group. Thus, further improvements in LE may now only be possible if some of the other underlying issues (for example, modification of lifestyle or behavioral factors) are tackled.

Accelerated diabetic retinopathy and late human immunodeficiency virus diagnosis.

To describe a case of rapidly progressive diabetic retinopathy in a patient who is human immunodeficiency virus positive. This is an observational case report. Fundus examination shows worsening of diabetic retinopathy with new vessels and vitreous hemorrhage in both eyes despite intense pan retinal photocoagulation. For patients with diabetes, additional diagnosis of human immunodeficiency virus increases the challenge of managing diabetic retinopathy as proliferation can appear rapidly and tends to worsen in these patients.

Late Diagnosis of Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy: Role of Socio-behavioral Factors and Medical Encounters

Despite provision of free-of-charge human immunodeficiency virus (HIV) care and antiretroviral therapy in Taiwan, a substantial proportion of patients experience late HIV diagnosis. We investigated the risk factors for late HIV diagnosis in Taiwan. Structured interviews were conducted among newly diagnosed HIV-infected patients to collect data on demographics, socio-behavioral variables and clinical profiles within 1 year preceding HIV diagnosis from August 2006 to July 2008. Multivariate analysis was performed to identify factors associated with missed opportunities for HIV testing and late HIV diagnosis (< 200 CD4 cells/μL). Among 227 newly diagnosed HIV-infected patients, 107 (47%) had late HIV diagnosis. Patients who had first positive tests for HIV at voluntary testing sites [odds ratio (OR): 0.22; 95% confidence interval (CI): 0.10-0.50], regular sexual partners at HIV diagnosis (OR: 0.30; 95% CI: 0.14-0.68), and unprotected sex in the preceding 3 months (OR: 0.16; 95% CI: 0.07-0.34) were less likely to have late HIV diagnosis. Missed opportunities for HIV testing after seeking medical attention occurred in 47 patients (20.7%) and were more common in patients with late HIV diagnosis than in those who received an earlier diagnosis (23.0% vs. 15.8%, p = 0.03). Patients with late HIV diagnosis were more likely than their counterparts to have received a diagnosis of seborrheic dermatitis (7.4% vs. 0.8%, p = 0.02) and community-acquired pneumonia (5% vs. 0%, p = 0.02), for which HIV testing was not offered by the health care providers. Late HIV diagnosis is not uncommon in Taiwan. Regular risk assessment and provision of routine HIV testing in medical encounters and increase of accessibility to voluntary HIV testing could facilitate earlier diagnosis of HIV infection.