Category: Federal Forum Posters
Purpose: Studies of missed opportunities for earlier diagnosis of HIV (MDO) have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before receiving their diagnosis. HIV late diagnosis (LD) (CD4 lymphocytes < 350/µl at diagnosis of the disease), deteriorates the condition of those affected, hinders recovery of immune status and increases the probability of transmission. The objective of the present study was to characterize missed opportunities for earlier HIV diagnosis in our health area.
Methods: All HIV patients diagnosed between January 2017 and December 2018 at a reference hospital in the Northwest of Spain were included. Epidemiological, laboratory and MDO (according to Recommendation guidelines for HIV diagnosis in Spain) were recorded. MDO were identified during the 5 years prior to diagnosis of the disease in primary and specialized care of our health area. A statistical analysis was performed using the STATA® 15 software.
Results: A total of 45 newly HIV/AIDS diagnoses, mean age 41.3±11.6 years and 80.0% men. 26.7% with a previous negative serology in the study period. 53.3% (24) with LD criteria and 40.0% (18) with AIDS. Risks factors: sexual contact (men who have sex with men (MSM) (27) and heterosexual (9)), parenteral drugs users (PDUs) (3) and unknown (6).
46 MDO were identified in 343 episodes of contact with the health care system. MDOs were detected in 24/45 patients (range 0-5 per patient), in 14/24 (58.3%) with LD criteria and in 11/18 (61.1%) with AIDS criteria at diagnosis. Distribution by care patient settings: primary care 20/187 (10.7%); specialist ambulatory consultations 16/65 (24.6%); urgent care 10/87 (11.5%); hospitalization 0/4 (0%).
Classification by MDO: 21/46 infections associated with HIV infection (sexually transmitted diseases, herpes zoster, tuberculosis...); 5/46 risk behaviors (toxic substances consumption/abuse, PDUs...); 3/46 symptomatology associated with HIV infection (chronic idiopathic diarrhea, unwarranted weight loss); 2/46 pathologies associated with HIV infection (peripheral neuropathy); 1/46 test that requires a prior serology. 14/46 were classified as nonspecific (symptomatology not indicative of HIV infection but which, associated with the baseline characteristics of the patients (age, MSM...), were considered MDO (recurrent infections, dermatological pathologies...)).
Conclusion: At least one MDO was detected in the 5 years prior to diagnosis in 53.3% of newly diagnoses. Of these, more than half of the patients were LD and 45.8% AIDS at diagnosis.
The specialist ambulatory consultations were the place with the highest proportion of MDO followed by urgent and primary care.
A high MDO rate was observed in our health area with important implications in the immunological status of the patient and the consequent risk of HIV transmission over time. Greater efforts will be necessary to implement and improve HIV screening in routine practice.