Associations of HIV testing and late diagnosis at a Japanese university hospital

Abstract

OBJECTIVES:This study was conducted to clarify the rate of late diagnosis of HIV infection and to identify relationships between the reasons for HIV testing and a late diagnosis.METHODS:This retrospective cohort study was conducted among HIV-positive patients at the Jikei University Hospital between 2001 and 2014. Patient characteristics from medical records, including age, sex, sexuality, the reason for HIV testing and the number of CD4-positive lymphocytes at HIV diagnosis, were assessed.RESULTS:A total of 459 patients (men, n=437; 95.2%) were included in this study and the median age at HIV diagnosis was 36 years (range, 18–71 years). Late (CD4 cell count <350/mm3) and very late (CD4 cell count <200/mm3) diagnoses were observed in 61.4% (282/459) and 36.6% (168/459) of patients, respectively. The most common reason for HIV diagnosis was voluntary testing (38.6%, 177/459 patients), followed by AIDS-defining illness (18.3%, 84/459 patients). Multivariate analysis revealed a significant association of voluntary HIV testing with non-late and non-very-late diagnoses and there was a high proportion of AIDS-defining illness in the late and very late diagnosis groups compared with other groups. Men who have sex with men was a relative factor for non-late diagnosis, whereas nonspecific abnormal blood test results, such as hypergammaglobulinemia and thrombocytopenia, were risk factors for very late diagnosis.CONCLUSIONS:Voluntary HIV testing should be encouraged and physicians should screen all patients who have symptoms or signs and particularly hypergammaglobulinemia and thrombocytopenia, that may nonspecifically indicate HIV infection.

Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

“…3). Herpes zoster was also commonly reported in HIV positive patients, with a prevalence of 6.9% in a primary care study [35], 1.3% [31] ,9% [20] and 5.5% [47] in secondary care settings and 4.6% in a tertiary care setting [48] (Fig. 4).…”

“…Other conditions and symptoms commonly reported were blood dyscrasias with prevalence in HIV infected individuals of 5% in primary care [39], 4% in primary and secondary care [38] and 6.4% in tertiary care [52]. Specifically, thrombocytopenia was a common blood disorder reported in HIV infected individuals across all settings [20,31,36,44,53,54]. The prevalence of seborrhoeic dermatitis in HIV infected individuals ranged from 1% to 2.7% in primary care [35,39], 4.2% in secondary care [47] and 2.1% [33] and 2.6% [48] in tertiary care (Fig.…”

“…Syphilis was a common STI found in individuals with HIV infection, present in 38% of HIV infected patients in Tokyo [31], 11% of MSM living with HIV [32] and 11% of individuals newly diagnosed with HIV in an Italian cohort study [33]. Gonorrhoea was also a common STI found in 27% of those newly diagnosed with HIV from a London HIV clinic [34] and 67 cases of gonorrhoea were reported prior to diagnosis in 1735 (3.8%) HIV infected individuals [33].…”

“…Kaposi sarcoma (Fig. 2) was a common cancer associated with immunosuppression seen among HIV positive patients in primary care [39], secondary care [31,42,43], secondary and tertiary setting [44,45] and across all 3 settings [46].…”

“…In HIV infected late presenters (presenting with AIDS defining illness and/or CD4 counts of <350 cells/µl) in Germany, 51% reported symptoms of candida oesophagitis and 40% with wasting syndrome [20]. Oral candidiasis was reported as a common condition in 4 studies [35,39,47,48] and oesophageal candidiasis in 5 studies [31,47,[49][50][51].…”