Late HIV presentation: epidemiology, clinical implications and management

Abstract

Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.

Keywords::

• delayed presentation
• human immunodeficiency virus
• immune suppression
• late presenters
• management
• treatment response

Financial & competing interests disclosure

Caroline Sabin has received consultancy fees from several pharmaceutical companies (Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Abbott) for membership of Data Safety and Monitoring Boards and Advisory Panels, honoraria for provision of educational courses and teaching materials, and sponsorship for attendance at conferences. Laura Waters has received honoraria for symposia and educational courses, consultancy fees and sponsorship to attend meetings and conferences from the following: Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Abbott, Merck Sharp & Dohme, Boehringer Ingelheim and ViiV Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.