Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort

Marie Helleberg, Frederik N Engsig, Gitte Kronborg, Alex Lund Laursen, Gitte Pedersen, Olav Larsen, Lars Nørregård Nielsen, Janne Jensen, Jan Gerstoft, Niels Obel

41 Citationer (Scopus)

Abstract

Abstract Background: We aimed to estimate the incidence and predictors of late presentation among human immunodeficiency virus (HIV)-infected individuals in Denmark. Methods: Incidence rates (IR) of presentation with advanced HIV (CD4 <200 cells/?l and/or acquired immune deficiency syndrome (AIDS)) and late presentation (CD4 <350 cells/?l and/or AIDS) were calculated per 100,000 population aged 16?60 y. Mortality rate ratios (MRR) were estimated using Poisson regression analysis. Results: Three thousand and twenty-seven individuals were diagnosed with HIV in 1995?2009; 34.7% presented with advanced HIV and 51.2% were late presenters. The IR of HIV was stable (6.2/100,000 population), but IR of presentation with advanced HIV declined during the study period from 2.2 (95% confidence interval (CI) 1.8?2.8) to 1.1 (95% CI 0.8?1.5). Age >50 y, heterosexuals of non-Danish origin, ?other? route of transmission, and diagnosis before 2002 were associated with an increased risk of presenting with advanced HIV, whereas a negative HIV test prior to diagnosis was associated with a significantly reduced risk. A total of 414 individuals (40.0%) had attended a hospital 1?3 y before presenting with advanced HIV. After 2002 the proportion of men who have sex with men with a negative HIV test prior to diagnosis increased (incidence rate ratio (IRR) 1.3, 95% CI 1.1?1.6), coinciding with a reduction in IR of presentation with advanced HIV. Mortality rates were increased the first 2 y following presentation with advanced HIV (MRR 5.9, 95% CI 3.6?9.4 and MRR 2.5, 95% CI 1.4?4.1, respectively). Conclusion: In a setting with a low HIV prevalence, the rate of presentation with advanced HIV can potentially be reduced by repeated HIV testing of individuals with a continuous high risk of transmission and by adhering to guidelines for targeted HIV testing.
OriginalsprogEngelsk
TidsskriftScandinavian Journal of Infectious Diseases
Vol/bind44
Udgave nummer4
Sider (fra-til)282-8
ISSN0036-5548
DOI
StatusUdgivet - 1 apr. 2012

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