Late presentation of HIV despite earlier opportunities for detection, experience from an Irish tertiary referral...

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.

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.

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).

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.