Late diagnosis of HIV infection: missed diagnostic opportunities

Background. To analyse the percentage of patients with a late diagnosis (LD) of HIV infection, their risk factors and the missed opportunities for an earlier diagnosis. Methods. One hundred and sixty-five patients diagnosed with HIV infection in Navarre between 2009 and 2013 were included. Logistic regression was used to study the factors associated with LD (CD4 <350 cells/mm(3) or AIDS defining disease at diagnosis). The presence of risk factors and clinical indicators of possible HIV infection in the 5 years preceding the diagnosis were analyzed. Results. The global prevalence of LD was 55% (90/165). This percentage was greater in immigrant patients than in Spanish patients, and in those without previous serology tests. An interaction was observed between the age and origin of patients. In Spaniards the risk of LD rose with age after 40 years (OR: 3.72; 95%CI 1.52-9.12) but this did not occur in immigrant patients. Of the 132 patients who had received medical care in the years prior to diagnosis, 20 (15%) had classical risk factors recorded in their history, 14 (11%) proceeded from regions with a high prevalence of HIV, and 46 (35%) had presented clinical indicators without a serology test being realized. Conclusions. In spite of multiple contacts with our health system, over half of the new cases of HIV infection are diagnosed late. Greater attention to clinical signs is needed and, above all, a better evaluation of the risk in asymptomatic patients.