HIV late presenters in Denmark: need for increased diagnostic awareness among general practitioners

The study objective was to describe demographic and clinical characteristics among HIV late presenters in a Danish university hospital.

Patients > 15 years of age were enrolled in this retrospective study. Data from the medical patient records were analyzed in accordance with the CD4 count at the time of HIV diagnosis.

Among 194 HIV patients (138 men and 56 women), 63 (33%) were diagnosed with a CD4 count below 200 cells/microlitre (late presenters). Heterosexuals constituted a larger proportion of patients in the late presenter group than did homosexual men (MSM) (p = 0.02), whereas a higher proportion of MSM than heterosexuals were diagnosed with HIV during primary infection (p < 0.01). Half of the late presenters had consulted a general practitioner three to 12 months prior to their HIV diagnosis. HIV antibody testing had not been performed although complaints consistent with possible underlying immune deficiency had been reported. Twenty per cent of the late presenters had a persistently low CD4 count below 200 cells/microlitre at follow-up despite having received HAART therapy for more than two years.

One third of the HIV patients in this study were diagnosed as late presenters, and this group featured a higher proportion of heterosexuals than of MSM. The HIV antibody test should be performed more consistently on solid clinical ground by general practitioners.