Two Decades of Late Diagnosis in HIV Infection: An Observational and Retrospective Study in a District Hospital | Chapter 12 | Issues and Developments in Medicine and Medical Research Vol. 3

 Background: In the European Union, Portugal has one of the highest incidence rates of HIV and AIDS, as well as one of the highest percentages of late diagnosis.

The goal of this study was to look for late diagnosis from 1998 to 2018. Data on demographics, epidemiology, and mortality are compared. Risk factors for a late presentation are identified.

Methods: Retrospective analysis of HIV patients who had their first visit between 1998 and 2018, separated into two groups: A: Lymphocyte TCD4+ count (TCD4+) 200 cells/l, and B: TCD4+ 200-350 cells/l. Statistical Package for the Social Sciences® (SPSS) 24.0 was used for the analysis.

Results: 613 individuals met the TCD4+ cell count in the database, however only 48 percent (n=533) matched all inclusion criteria, with 65.5 percent (n=349) in group A. A vs. B group analysis: Male preponderance (80.2%) vs. 67.4% (p=0.001); age at first visit >40 years. 52.4 percent vs. 35.9% (p=0.001), increasing over time (p0.001); heterosexual risk 55.3 percent vs. 52.7 percent, increasing over time (p0.001); intra-hospital referral 50.4% vs. 23.9 percent (p0.001). 66.2 percent vs. 31.0 percent (p0.001) had an AIDS-defining disease, the most common of which was TB (19.5 percent vs. 17.9 percent ). The male gender, age >40 years (especially in men), and in-hospital diagnosis were all identified to be risk factors for presenting with advanced disease in this study, implying that this subgroup had failed all previous screening opportunities. Group A had a higher mortality rate (28.7%, p=0.020) and a shorter survival duration (1828 [433-3675] days, p=0.008).Conclusion: Male gender (OR=2.00, 95 percent CI 1.25 to 3.20, p=0.004), age over 40 years (OR=1.79, 95 percent CI 1.19 to 2.71, p=0.006), and intra-hospital diagnosis (OR=3.16, CI 95 percent 2.10 to 4.76, p=0.001) are all risk factors for extremely late presentation (TCD4+ 200 cells/l). Women showed no increase in risk over 40 years (OR=0.90, CI 95 percent 0.40 to 2.07, p=0.809).

These findings highlight the necessity of early HIV diagnosis, which has global and public health ramifications.

Author(S) Details

R. Correia de Abreu
Department of Infectious Diseases Service, Hospital Pedro Hispano, Portugal.

F. Guimarães
School of Medicine, Minho University, Portugal.

J. Laranjinha
Department of Infectious Diseases Service, Hospital Pedro Hispano, Portugal.

F. Duarte
Department of Infectious Diseases Service, Hospital Pedro Hispano, Portugal.

I. Neves
Department of Infectious Diseases Service, Hospital Pedro Hispano, Portugal.

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