Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey

Abstract

Background

Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected.

Methods

The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as “not late”.

Results

Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004).

Conclusion

HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.

Plain Language Summary

Late diagnosis of HIV remains a challenge, leading to increased health problems, deaths, and societal costs. This study aimed to determine the rates of late diagnosis and patient characteristics in Turkey, using a new definition that excludes recently infected individuals. The study included 794 treatment-naïve patients, mostly male with an average age of 36 years. With the new definition, 47.2% were diagnosed late, and 23% had advanced disease. The pandemic period saw higher rates of late diagnosis (55.8% vs 44.2%) and advanced disease (30.1% vs 20.6%). Gender did not significantly affect late diagnosis. Patients with late diagnosis were older, had lower CD4 counts, poorer treatment response, higher mortality rates (4.8% vs 1.2%), and shorter survival. Older age and disruptions in healthcare during the pandemic were identified as risk factors for late diagnosis. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors, while focusing on screening high-risk populations, raising awareness among underdiagnosed groups, and promoting testing even during challenging situations.

Keywords:

• human immunodeficiency virus
• HIV
• late diagnosis
• new definition
• risk factors

Data Sharing Statement

If needed, data supporting the results will be shared.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

Dr Yeşim Taşova reports personal fees, non-financial support from Gilead, personal fees, non-financial support from GSK, personal fees from Pfizer, personal fees from MSD, outside the submitted work. The authors report no other conflicts of interest financial or otherwise about this work.