Late diagnosis of HIV infection at two academic medical centers: 1994–2004

Abstract

Over the last decade, there has been increased attention to the role of earlier HIV testing in the United States. Our objective was to determine if this has translated into changes in the proportion of inpatients with advanced disease at the time of initial HIV diagnosis. We identified inpatients discharged with a new diagnosis of HIV infection or AIDS between 1994 and 2004 at two academic medical centers. We examined trends in initial CD4 count at diagnosis over three time periods: 1994–1996, 1997–2000 and 2001–2004. Between 1994 and 2004, 235 inpatients were newly diagnosed with HIV infection or AIDS in the two centers. For the 217 patients with available CD4 count data, the median initial CD4 count was 41/µl (interquartile range 19–138/µl). Of the 217 patients, 184(85%) had CD4 ≤200/µl and 119/217 (55%) had CD4 ≤50/µl. There were no significant differences in median CD4 count by time period. A large majority of inpatients with newly diagnosed HIV infection at two academic medical centers between 1994 and 2004 had signs of advanced immunodeficiency. Over this recent 11-year period there was no evidence that inpatients with a new HIV diagnosis were identified at earlier stages of disease.

Keywords:

• HIV infections/testing
• HIV infections/epidemiology
• HIV infections/diagnosis

Acknowledgements

The study was supported in part by the National Institute of Allergy and Infectious Diseases (K23 AI01794, K24 AI062476, R37AI42006, and P30 AI060345) and by the Doris Duke Charitable Foundation, Clinical Scientist Development Award to Rochelle P. Walensky, MD, MPH. We would like to thank Elena Losina, PhD for assistance with statistical analysis.