Irish Journal of Medical Science

, Volume 182, Issue 3, pp 389–394

Late presentation of HIV despite earlier opportunities for detection, experience from an Irish Tertiary Referral Institution

  • O’Shea. D
  • M. Ebrahim
  • A. Egli
  • D. Redmond
  • S. McConkey
Original Article

DOI: 10.1007/s11845-012-0898-2

Cite this article as:
D, O., Ebrahim, M., Egli, A. et al. Ir J Med Sci (2013) 182: 389. doi:10.1007/s11845-012-0898-2

Abstract

Objectives

Late presentation of HIV continues to undermine advances in the management of HIV. Opportunities to detect HIV at an earlier stage are often missed. Current estimates suggest that undiagnosed individuals comprise approximately one quarter of all people in the western world living with HIV. ‘Testing-and-treating’ this group has been proposed as a means to curb the HIV epidemic. In this study we assessed the characteristics of individuals newly diagnosed with HIV, and their utilisation of healthcare services in Ireland prior to their diagnosis.

Methods

A retrospective review was undertaken of all patients newly diagnosed with HIV over a 27-month period. Patient demographics were recorded, as were details of healthcare contacts in the year preceding diagnosis. Individuals detected via screening of recent immigrants/asylum seekers were excluded.

Results

In the period studied 114 patients received a new diagnosis of HIV, 59 met inclusion criteria. The majority (54 %) fulfilled the European consensus definition for late presenters (CD4 < 350 cells/µl). ‘Late presenters’ were significantly more likely to be symptomatic at diagnosis (OR = 4.62; 95 % CI 1.45–14.67; p = 0.015), diagnosed by acute tertiary hospital services (p = 0.015), and 56 % reported heterosexual mode of acquisition (OR = 2.12; 95 % CI 0.73–6.16; p = 0.19). Patients detected via screening had significantly higher CD4 counts at diagnosis compared with those diagnosed due to symptoms (Median CD4 422 cells/µl; IQR 285–594 vs. 142 cells/µl; IQR 62–333; p = 0.0007). ‘Symptomatic’ patients were significantly more likely to report prior healthcare contacts (OR 4.71; 95 % CI 1.32–16.79; p = 0.013).

Conclusion

Current screening activities are inadequate. Unfortunately newly diagnosed HIV patients continue to be symptomatic, at advanced stages of disease, to acute hospital services. Heterosexual groups in particular are at risk for late detection.

Keywords

HIV Late presenters Missed diagnostic opportunities HIV screening 

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • O’Shea. D
    • 1
    • 4
  • M. Ebrahim
    • 2
  • A. Egli
    • 3
  • D. Redmond
    • 1
  • S. McConkey
    • 1
    • 2
  1. 1.Department of Infectious Diseases and Tropical MedicineBeaumont HospitalDublin 9Ireland
  2. 2.Department of International Health and Tropical MedicineRoyal College of Surgeons in IrelandDublin 2Ireland
  3. 3.Alberta Transplant Institute, Li Ka Shing Institute of VirologyUniversity of AlbertaEdmontonCanada
  4. 4.Department of Infectious Diseases and Tropical MedicineBeaumont HospitalBeaumont, Dublin 9Ireland

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