Late presentation to HIV testing is overestimated when based on the consensus definition
A Sasse1, E Florence2, A Pharris3
1Scientific Institute of Public Health, Brussels, Belgium.
HIV Medicine
|July 30, 2015
Summary
The current definition of late HIV presentation may overestimate cases, especially in recent infections. Considering clinical stage can provide a more accurate assessment of late HIV diagnosis.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- A 2011 consensus defined late presenters (LPs) by CD4 count < 350 cells/μL or AIDS-defining event.
- Transient low CD4 counts can occur in recent HIV infections, potentially misclassifying individuals.
Purpose of the Study:
- To evaluate how incorporating clinical stage affects the measurement of late HIV presentation.
- To assess the impact of recent infections on the accuracy of the current LP definition.
Main Methods:
- Analysis of Belgian HIV surveillance data (1998-2012) for 7949 newly diagnosed patients.
- CD4 count, AIDS-defining events, and clinician-reported recent infections (< 6 months) were recorded.
- Patients were classified using the consensus definition and then reclassified if infections were recent.
Main Results:
- Recent infections increased from 8.2% (1998) to 37.5% (2012).
- Considering clinical stage significantly reduced LP classification: 18.2% of MSM in 2012 were LPs vs. 30.9% by consensus (P < 0.001).
- Misclassification of LPs due to transient low CD4 counts rose from 5% (1998) to 41% (2012) in MSM.
Conclusions:
- The consensus definition may overestimate late HIV presentation in individuals with recent infections.
- Transient low CD4 counts can lead to inaccurate LP estimates.
- Clinical stage should be considered for a more precise definition of late HIV presentation.
