AIDS and Behavior

, Volume 23, Issue 4, pp 920–928 | Cite as

Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala

  • Johanna MeléndezEmail author
  • Samuel W. Reinhardt
  • Jane A. O’Halloran
  • Andrej SpecEmail author
  • Andrea Alonzo Cordon
  • William G. Powderly
  • Carlos Mejia Villatoro
Original Paper


Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3686 patients, 2990 (81.1%) were LP who were more likely to be male (60.2% vs. 48.0%, p < 0.0001), heterosexual (88.0% vs. 78.0%, p < 0.0001) and rural dwellers (43.7% vs. 33.8%. p < 0.0001). The proportions of patients who presented late or with AIDS at diagnosis decreased over time. Only 665 patients (18.2%) sought care in the 2 years prior to HIV diagnosis. This study, the first of its kind in Central America to focus on late presenters and missed opportunities for HIV diagnosis, demonstrates extremely high rates of LP in Guatemala. Although in recent years rates of LP have improved somewhat, the need for screening outside of traditional healthcare settings is apparent.


HIV Guatemala Diagnosis AIDS 


El diagnóstico precoz del VIH sigue siendo un desafío en muchas regiones, y un diagnóstico tardío está relacionado con aumento de la morbi-mortalidad. Este estudio retrospectivo de una cohorte de personas viviendo con VIH en seguimiento en un centro atención terciaria en ciudad de Guatemala, describe la proporción de presentadores tardíos (PT) y las oportunidades perdidas para diagnosticarlas. De 3686 pacientes analizados, 2990 (81.1%) eran PT, los cuales eran con mayor frecuencia varones (60.2% vs. 48.0%, p < 0.0001), heterosexuales (88.0% vs. 78.0%, p < 0.0001) y habitantes de un área rural (43.7% vs. 33.8%. p < 0.0001). La proporción de PT disminuyó a lo largo del tiempo. Únicamente 665 pacientes (18.2%) buscaron atenciٕón médica en los dos años previos al diagnóstico del VIH. Este estudio, el primero en Centro América en enfocarse en presentadores tardios y oportunidades perdidas en el diagnostico del VIH, demuestra una tasa extremadamente alta de PT en Guatemala. A pesar de que en años recientes la tasa de PT ha mejorado, es evidente la necesidad de realizar tamizaje fuera del ambiente sanitario habitual.



Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

Compliance with Ethical Standards

Conflict of interest

WP has received research grants through his institution from Merck & Co. and has served on advisory board for Merck & Co. and Gilead Sciences. JM, SR, JOH, AS and AAC declare that they have no relevant conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2018_2331_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Johanna Meléndez
    • 1
    Email author
  • Samuel W. Reinhardt
    • 2
  • Jane A. O’Halloran
    • 3
  • Andrej Spec
    • 3
    Email author
  • Andrea Alonzo Cordon
    • 1
  • William G. Powderly
    • 3
  • Carlos Mejia Villatoro
    • 1
  1. 1.Department of Internal Medicine, Infectious Diseases ClinicRoosevelt HospitalGuatemala CityGuatemala
  2. 2.Department of MedicineWashington University School of MedicineSt. LouisUSA
  3. 3.Division of Infectious DiseasesWashington University School of MedicineSt. LouisUSA

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