The Forgotten Test: Missed Opportunities for HIV Diagnosis and Survival Outcomes in Advanced HIV Disease

Area of Science:

• Infectious Diseases
• Public Health
• Immunology

Background:

• Advanced HIV disease (AHD) presents a significant public health challenge due to high morbidity and mortality.
• Late diagnosis of HIV remains a critical issue, contributing to poor patient outcomes.
• Missed opportunities for early HIV detection persist, particularly among vulnerable populations.

Purpose of the Study:

• To investigate the frequency of missed diagnostic opportunities in individuals presenting with AHD.
• To identify factors associated with late HIV diagnosis.
• To evaluate clinical outcomes and survival rates in patients with AHD.

Main Methods:

• A multicenter retrospective cohort study was conducted involving antiretroviral-naive people with HIV (PWH) diagnosed with AHD (CD4 < 200 cells/µL and/or AIDS).
• Data collected included demographics, clinical and viro-immunological parameters, healthcare contacts, symptoms, and prior HIV testing history.
• Structured interviews were used to gather information on healthcare utilization and testing behaviors in the two years preceding diagnosis.

Main Results:

• Out of 658 newly diagnosed PWH, 224 (34%) presented with AHD, with 54% having AIDS.
• A significant majority (86.2%) had no prior HIV testing.
• Nearly 30% accessed healthcare for HIV-compatible symptoms without receiving an HIV test in the year before diagnosis.
• One-year virological suppression was achieved by 84.2%, with a median CD4 count of 260 cells/µL.
• Five-year survival was higher for non-AIDS presenters (100%) compared to AIDS presenters (85%).

Conclusions:

• Missed opportunities for HIV diagnosis are frequent among individuals presenting with AHD, even with prior healthcare engagement.
• Indicator condition-guided HIV testing strategies are essential to mitigate late diagnoses.
• Implementing targeted testing approaches can improve long-term outcomes for PWH and reduce AHD burden.