The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis

BMC Infectious Diseases

Enrico Girardi¹  Giuseppe Ippolito¹  Vincenzo Puro¹  Nicoletta Orchi¹  Angela Corpolongo¹  Alessandro Sampaolesi¹  Susanna Grisetti¹  Anna Rita Buonomini²  Stefano Aviani Barbacci⁴  Claudio Maria Mastroianni³  Massimo Giuliani⁵  Gabriella De Carli¹  Giacomina Chiaradia¹  Paola Scognamiglio¹ 

[1] National Institute for Infectious Diseases “L. Spallanzani” (IRCCS), Via Portuense 292, Rome 00149, Italy;Clinic of Infectious Diseases, Tor Vergata University, Rome, Italy;CRAIDS S.M. Goretti Hospital, Sapienza University, Latina, Italy;CRAIDS Belcolle Hospital, Viterbo, Italy;San Gallicano Dermatological Institute (IRCCS), Rome, Italy

关键词: Late diagnosis;    Sexually transmitted infections;    Indicator diseases;    HIV testing;   

Others  :  1145700
DOI  :  10.1186/1471-2334-13-473

 received in 2012-12-18, accepted in 2013-09-19,  发布年份 2013

【 摘 要 】

Background

The aim of our work was to evaluate the potential impact of the European policy of testing for HIV all individuals presenting with an indicator disease, to prevent late diagnosis of HIV. We report on a retrospective analysis among individuals diagnosed with HIV to assess whether a history of certain diseases prior to HIV diagnosis was associated with the chance of presenting late for care, and to estimate the proportion of individuals presenting late who could have been diagnosed earlier if tested when the indicator disease was diagnosed.

Methods

We studied a large cohort of individuals newly diagnosed with HIV infection in 13 counselling and testing sites in the Lazio Region, Italy (01/01/2004-30/04/2009). Considered indicator diseases were: viral hepatitis infection (HBV/HCV), sexually transmitted infections, seborrhoeic dermatitis and tuberculosis. Logistic regression analysis was performed to estimate association of occurrence of at least one indicator disease with late HIV diagnosis.

Results

In our analysis, the prevalence of late HIV diagnosis was 51.3% (890/1735). Individuals reporting at least one indicator disease before HIV diagnosis (29% of the study population) had a lower risk of late diagnosis (OR = 0.7; 95%CI: 0.5-0.8) compared to those who did not report a previous indicator disease. 52/890 (5.8%) late presenters were probably already infected at the time the indicator disease was diagnosed, a median of 22.6 months before HIV diagnosis.

Conclusions

Our data suggest that testing for HIV following diagnosis of an indicator disease significantly decreases the probability of late HIV diagnosis. Moreover, for 5.5% of late HIV presenters, diagnosis could have been anticipated if they had been tested when an HIV indicator disease was diagnosed.

However, this strategy for enhancing early HIV diagnosis needs to be complemented by client-centred interventions that aim to increase awareness in people who do not perceive themselves as being at risk for HIV.

【 授权许可】

   
2013 Scognamiglio et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Antiretroviral Therapy Cohort Collaboration: Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008, 372:293-299.
• [2]Hamers FF, Phillips AN: Diagnosed and undiagnosed HIV-infected populations in Europe. HIV Med 2008, 9(Suppl 2):6-12.
• [3]Johnson M, Sabin C, Girardi E: Definition and epidemiology of late presentation in Europe. Antivir Ther 2010, 15(Suppl 1):3-8.
• [4]Likatavicius G, Van de Laar MJ: HIV and AIDS in the European Union, 2009. Euro Surveill 2010, 15(48):19737.
• [5]Centers for Disease Control and Prevention (CDC): Persons tested for HIV–United States, 2006. MMWR Morb Mortal Wkly Rep 2008, 57:845-849.
• [6]Althoff KN, Gange SJ, Klein MB, Brooks JT, Hogg RS, Bosch RJ, Horberg MA, Saag MS, Kitahata MM, Justice AC, Gebo KA, Eron JJ, Rourke SB, Gill MJ, Rodriguez B, Sterling TR, Calzavara LM, Deeks SG, Martin JN, Rachlis AR, Napravnik S, Jacobson LP, Kirk GD, Collier AC, Benson CA, Silverberg MJ, Kushel M, Goedert JJ, McKaig RG, Van Rompaey SE, et al.: Late presentation for human immunodeficiency virus care in the United States and Canada. Clin Infect Dis 2010, 50:1512-1520.
• [7]Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE, Centers for Disease Control and Prevention (CDC): Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006, 55:1-17.
• [8]Merchant RC, Waxman MJ: HIV screening in health care settings: some progress, even more questions. JAMA 2010, 304:348-349.
• [9]Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, Leon A, Begovac J, Brinkman K, Zangerle R, Grzeszczuk A, Vassilenko A, Hadziosmanovic V, Krasnov M, Sönnerborg A, Clumeck N, Gatell J, Gazzard B, Monforte A, Rockstroh J, Lundgren JD: Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One 2013, 8:e52845.
• [10]Rayment M, Thornton A, Mandalia S, Elam G, Atkins M, Jones R, Nardone A, Roberts P, Tenant-Flowers M, Anderson J, Sullivan AK, HINTS Study Group: HIV testing in non-traditional settings-the HINTS study: a multi-centre observational study of feasibility and acceptability. PLoS One 2012, 7:e39530.
• [11]Gazzard B, Clumeck N, D’Arminio Monforte A, Lundgren JD: Indicator disease-guided testing for HIV–the next step for Europe? HIV Med 2008, 9(Suppl. 2):34-40.
• [12]HIV in Europe initiative: HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings. available at http://www.hiveurope.eu/LinkClick.aspx?fileticket=b8rDoBh8NjM=&tabid=37 webcite
• [13]Orchi N, Balzano R, Scognamiglio P, Navarra A, De Carli G, Elia P, Grisetti S, Sampaolesi A, Giuliani M, De Filippis A, Puro V, Ippolito G, Girardi E, SENDIH Group: Ageing with HIV: newly diagnosed older adults in Italy. AIDS Care 2008, 20:419-425.
• [14]Mammone A, Pezzotti P, Angeletti C, Orchi N, Carboni A, Navarra A, Sciarrone MR, Sias C, Puro V, Guasticchi G, Ippolito G, Borgia P, Girardi E, SENDIH Study Group: HIV incidence estimate combining HIV/AIDS surveillance, testing history information and HIV test to identify recent infections in Lazio, Italy. BMC Infect Dis 2012, 12:65. BioMed Central Full Text
• [15]Harris T, Panaro L, Phypers M, Choudhri Y, Archibald CP: HIV testing among Canadian tuberculosis cases from 1997 to 1998. Can J Infect Dis Med Microbiol 2006, 17:165-168.
• [16]Rodger AJ, Story A, Fox Z, Hayward A, London Tuberculosis Nurses Network: HIV prevalence and testing practices among tuberculosis cases in London: a missed opportunity for HIV diagnosis? Thorax 2010, 65:63-69.
• [17]Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, Girardi E, Johnson M, Kirk O, Lundgren J, Mocroft A, D'Arminio Monforte A, Phillips A, Raben D, Rockstroh JK, Sabin C, Sönnerborg A, De Wolf F, European Late Presenter Consensus Working Group: Late presentation of HIV infection: a consensus definition. HIV Med 2011, 12:61-64.
• [18]Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, Pantazis N, Amo JD, Johnson AM, Babiker A, Porter K, CASCADE Collaboration in EuroCoord: Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis 2011, 53:817-825.
• [19]Adler A, Mounier-Jack S, Coker RJ: Late diagnosis of HIV in Europe: definitional and public health challenges. AIDS Care 2009, 21:284-293.
• [20]Borghi V, Girardi E, Bellelli S, Angeletti C, Mussini C, Porter K, Esposito R: Late presenters in an HIV surveillance system in Italy during the period 1992–2006. J Acquir Immune Defic Syndr 2008, 49:282-286.
• [21]Castilla J, Sobrino P, de la Fuente L, Noguer I, Guerra L, Parras F: Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. AIDS 2002, 16:1945-1951.
• [22]Delpierre C, Dray-Spira R, Cuzin L, Marchou B, Massip P, Lang T, Lert F, VESPA Study Group: Correlates of late HIV diagnosis: implications for testing policy. Int J STD AIDS 2007, 18:312-317.
• [23]Klein D, Hurley LB, Merrill D, Quesenberry CP Jr, for Consortium for HIV/AIDS Interregional Research: Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection: implications for early detection. J Acquir Immune Defic Syndr 2003, 32:143-152.
• [24]Ellis S, Curtis H, Ong EL, British HIV Association (BHIVA); BHIVA Clinical Audit and Standards sub-committee: HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clin Med 2012, 12:430-434.
• [25]Lo YC, Wu PY, Hsieh CY, Chen MY, Sheng WH, Hsieh SM, Sun HY, Liu WC, Hung CC, Chang SC: Late diagnosis of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: role of socio-behavioral factors and medical encounters. J Formos Med Assoc 2011, 110:306-315.
• [26]Duffus WA, Weis K, Kettinger L, Stephens T, Albrecht H, Gibson JJ: Risk-based HIV testing in South Carolina health care settings failed to identify the majority of infected individuals. AIDS Patient Care STDS 2009, 23:339-345.
• [27]Jenkins TC, Gardner EM, Thrun MW, Cohn DL, Burman WJ: Risk based human immunodeficiency virus (HIV) testing fails to detect the majority of HIV-infected persons in medical care settings. Sex Transm Dis 2006, 33:329-333.
• [28]Liddicoat RV, Horton NJ, Urban R, Maier E, Christiansen D, Samet JH: Assessing missed opportunities for HIV testing in medical settings. J Gen Intern Med 2004, 19:349-356.
• [29]Antonucci G, Girardi E, Raviglione MC, Ippolito G: Risk factors for tuberculosis in HIV-infected persons. A prospective cohort study. The Gruppo Italiano di Studio Tubercolosi e AIDS (GISTA). JAMA 1995, 274:143-148.
• [30]Kwan CK, Ernst JD: HIV and tuberculosis: a deadly human syndemic. Clin Microbiol Rev 2011, 24:351-376.
• [31]Nnoruka EN, Chukwuka JC, Anisuiba B: Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression. Int J Dermatol 2007, 46(Suppl.2):14-18.
• [32]Harrison KM, Kajese T, Hall HI, Song R: Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008, 123:618-627.
• [33]Krain A, Wisnivesky JP, Garland E, McGinn T: Prevalence of human immunodeficiency virus testing in individuals with hepatitis B and C infection. Mayo Clin Proc 2004, 79:51-56.
• [34]Søgaard OS, Lohse N, Østergaard L, Kronborg G, Røge B, Gerstoft J, Sørensen HT, Obel N: Morbidity and risk of subsequent diagnosis of HIV: a population based case control study identifying indicator diseases for HIV infection. PLoS One 2012, 7:e32538.