The late‐presenting <scp>HIV</scp>‐infected patient 30 years after the introduction of <scp>HIV</scp> testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis

Tominski, Daniela; Katchanov, Juri; Driesch, Dominik; Daley, MB; Liedtke, Anna; Schneider, A; Slevogt, Hortense; Arastéh, Keikawus; Stocker, Hartmut

doi:10.1111/hiv.12403

Cited by 48 publications

(50 citation statements)

References 25 publications

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“…Recent studies in developed countries have demonstrated that non-traditional risk groups including women, heterosexual individuals and older adults are more likely to be tested later in the course of HIV infection [7–9]. These data provide important information for policy-making regarding HIV screening strategies in those settings.…”

Section: Introductionmentioning

confidence: 99%

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China

et al. 2017

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Delayed diagnosis of HIV infection is associated with advanced immunosuppression and increased risk of onward transmission. Little data exists regarding factors associated with diagnostic delays among patients presenting with advanced HIV disease in China. Medical records of patients with HIV/AIDS hospitalized at a 2000-bed tertiary hospital in Beijing, China between 1997 and 2012 were retrospectively reviewed. Demographic and clinical data of patients newly diagnosed with HIV at the hospital were abstracted. Patient characteristics, disease parameters, and the time interval between the first medical visit and the visit leading to HIV diagnosis were compared among three periods: 1997–2002, 2003–2008 and 2009–2012. Chi-square, Kruskal-Wallis and logistic regression analyses were used as appropriate. A quarter of patients (72/279) were newly diagnosed with HIV at the hospital, consisting of 11, 29 and 32 patients in 1997–2002, 2003–2008 and 2009–2012 respectively. The median time delay between the first medical visit and the visit leading to HIV diagnosis decreased over time from 91 days among patients diagnosed before 2002, to 75 days between 2003 to 2008, and 39 days after 2009 (p = 0.036). However, the median CD4+T cell count at diagnosis was 26 cells/μL [interquartile range 3–132 cells/μL] in 1997–2002, and remained unchanged across time intervals. Forty-one (57%) patients had AIDS-defining conditions and Pneumocystis jiroveci pneumonia was the most common opportunistic infection (31 cases). These results reveal persistent missed opportunities for timely HIV testing among patients with advanced disease. Strategies for promoting early HIV testing in healthcare settings are needed in China.

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Section: Introductionmentioning

confidence: 99%

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China

et al. 2017

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“…This figure compares to 53% mentioning and 38% recommending HIV testing in comparable UK findings. 16 In our own experience 15 and the experience of others, [19][20][21][22] missed opportunities for diagnosis are likely to be followed by later presentation to hospital with AIDS-defining events. Early diagnosis and screening are likely to reduce morbidity and mortality and be cost effective.…”

Section: Discussionmentioning

confidence: 91%

Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?

Lin

Eades

Nair

et al. 2020

Internal Medicine Journal

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Background Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition‐based testing, adapted from the European AIDS Clinical Society (EACS) guidelines. Aim To evaluate the extent that Australian non‐HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions. Methods EACS guidelines were reviewed to produce a list of 24 AIDS‐defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non‐diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study. Results Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty‐five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty‐five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing. Conclusions Although almost half of HIV non‐HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV.

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“…There are rare reports of candidiasis associated with immune reconstitution inflammatory syndrome, including a case of Candida meningitis leading to fatal vasculitis . Despite the dramatic decline in candidiasis (oesophageal and oropharyngeal) with cART, there remains a residual level in people living with HIV above that in HIV‐seronegative individuals .…”

Section: Prophylaxis and Impact Of Cartmentioning

confidence: 99%

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019

et al. 2019

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The late‐presenting HIV‐infected patient 30 years after the introduction of HIV testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis

Abstract: Indicator conditions are still missed by clinicians. Women and 'non-MSM' are at highest risk of presenting with an indicator condition but not being tested for HIV infection.

Cited by 48 publications

References 25 publications

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China

Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019

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