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Many patients in the United Kingdom and Ireland are not having their HIV infection diagnosed until they are at a late stage of disease, finds a study published online by the British Medical Journal (BMJ) today. These findings reflect national trends reported by the Health Protection Agency.
Researchers surveyed more than 100 centers providing adult HIV care in the United Kingdom and Ireland for patients presenting with a new diagnosis of HIV infection from January to March 2003.
Of 977 patients identified, one third presented late. This was more common in older patients and in black Africans, but less likely in homosexual men, regardless of age and ethnicity. Less than half of patients (41 percent) were diagnosed as part of routine screening.
In the year before diagnosis, 168 patients (17 percent) sought medical care with HIV related symptoms but remained undiagnosed. Data show that 160 patients had a white blood cell count below the threshold for initiating treatment according to British HIV Association guidelines, indicating that treatment may have been delayed.
"We found a significant number of missed opportunities for earlier diagnosis of HIV infection," say the authors.
There are well recognized advantages of early diagnosis of HIV and starting appropriate treatment with highly active antiretroviral therapy, they write. To improve this situation, the proportion of people diagnosed as having HIV as part of routine screening needs to increase, with people at risk being encouraged to have an HIV test.
Healthcare professionals' awareness of factors associated with late presentation of HIV infection and conditions likely to be related to HIV also need to increase.
Improving the offering and uptake of HIV testing both as part of routine screening and as indicated by associated medical conditions should reduce the number of undiagnosed HIV infections, they conclude.