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

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/μl and/or acquired immune deficiency syndrome (AID...

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Published in:Scandinavian journal of infectious diseases Vol. 44; no. 4; pp. 282 - 288
Main Authors: Helleberg, Marie, Engsig, Frederik N., Kronborg, Gitte, Laursen, Alex Lund, Pedersen, Gitte, Larsen, Olav, Nielsen, Lars, Jensen, Janne, Gerstoft, Jan, Obel, Niels
Format: Journal Article
Language:English
Published: England Informa Healthcare 01.04.2012
Taylor & Francis
Subjects:
Adult
Cohort Studies
Denmark - epidemiology
Disease Progression
Female
HIV
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV Infections - mortality
HIV Infections - transmission
HIV testing
Humans
Incidence
late presentation
Male
Middle Aged
mortality
Multivariate Analysis
presentation with advanced HIV
Risk Factors
Denmark
ISSN:0036-5548, 1651-1980, 1651-1980
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Summary: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/μl and/or acquired immune deficiency syndrome (AIDS)) and late presentation (CD4 < 350 cells/μl 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.
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ISSN:0036-5548
1651-1980
1651-1980
DOI:10.3109/00365548.2011.626440