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Missed opportunities for diagnosing HIV are denying patients the benefit of early treatment, say researchers. More patients at risk should be encouraged to have an HIV test, and health professionals must get better at recognising symptoms of the infection.
This follows a national case review of new diagnoses of HIV infection between January and March 2003 by a survey to all adult HIV care providers in the United Kingdom and Ireland. The survey covered clinical and immune state and symptoms or episodes in the previous 12 months.
A third of the 977 patients identified had presented late, as indicated by a CD4 lymphocyte count <200 cells/μl. They were commonly older patients and black Africans. Diagnosis as part of a routine screen and testing at genitourinary, sexual health, and HIV clinics were both independently associated with a lower chance of late diagnosis, after adjustment for demographic confounders. Seventeen per cent (168) of all patients had had an episode in the previous year suggesting HIV infection, including 58 hospital admissions. In 160 of these patients CD4 counts were below the threshold for starting treatment advocated by the British HIV Association, possibly indicating delayed treatment. The response rate to the survey was 76% (113/148).
The results reflect a national trend for late diagnosis of HIV infection reported by the Health Protection Agency. Estimates in 2001 disclosed that 59% of patients with HIV in the United Kingdom starting treatment had low CD4 counts (<200 cells/μl), mainly owing to late diagnosis.