Late presentation to HIV testing is overestimated when based on the consensus definition

Abstract

ObjectivesIn 2011, a consensus was reached defining “late presenters” (LPs) as individuals presenting for care with a CD4 count < 350 cells/μL or with an AIDS‐defining event, regardless of CD4 count. However, a transient low CD4 count is not uncommon in recent infections. The objective of this study was to investigate how measurements of late presentation change if the clinical stage at the time of diagnosis is taken into account.MethodsCase surveillance data for newly diagnosed patients in Belgium in 1998–2012 were analysed, including CD4 count at diagnosis, the presence of AIDS‐defining events, and recent infections (< 6 months) as reported by clinicians in the case of acute illness or a recent negative test. First, proportions of LPs were calculated according to the consensus definition. Secondly, LPs were reclassified as “nonlate” if infections were reported as recent.ResultsA total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P < 0.001). The proportion of patients misclassified as LPs increased significantly over time: 5% in MSM in 1998 vs. 41% in 2012.ConclusionsThis study suggests that low CD4 counts in recent infections may lead to overestimation of late presentation when applying the consensus definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered.

Health and budget impact of combined HIV prevention – first results of the BELHIVPREV model

“…Based on available research and modelling data, it is assumed that between 10% and 20% of the current HIV population is undiagnosed [14]. For our model, we used an estimate of 12% undiagnosed HIV patients at the end of 2014.…”

“…This proportion was approximated based on reported numbers of patients not achieving a viral load (VL) of <200 copies/ml after receiving at least 6 months of antiretroviral therapy. According to Sasse et al, 96% of patients treated in an AIDS reference centre at the end of 2015 achieved a VL < 200 [14], meaning that 4% of treated patients were still infectious. This percentage was assumed to remain constant over time.…”

Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)

“…Several public health campaigns have improved general awareness of HIV and risky sexual behaviour (European Centre for Disease Prevention and Control, 2012;Sensoa, 2012 (Sasse et al, 2012;Sasse et al, 2013). In 2013, the Belgian Scientific Institute of Public Health reported 1115 newly infected HIV patients: 50% infected via homosexual contact and 45% via heterosexual contact.…”

“…Looking at heterosexual transmission, the detected new HIV diagnoses decreased by 19% between 2012 and 2013. In the same period, infections through homosexual contact increased by 5% (Sasse et al, 2014). The increasing trend of HIV diagnoses among MSM is prominent in urban areas in Flanders: the majority of HIV-infected MSM live in the cities of Brussels, Antwerp, Leuven and Ghent.…”

“…The increasing trend of HIV diagnoses among MSM is prominent in urban areas in Flanders: the majority of HIV-infected MSM live in the cities of Brussels, Antwerp, Leuven and Ghent. In addition, 40% of the newly detected HIV diagnoses in MSM in 2013 are late diagnoses (CD4 < 350/mm 3 at the moment of the HIV diagnosis), compared with 30% late diagnoses among MSM in 2012 (Sasse et al, 2014).…”