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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update

Frequent Failed HIV Detection in a High Prevalence Area:




 

AIDS Patient Care and STDs (06.03) Vol. 17; No. 6: P. 277- 282

Data indicate that the majority of at-risk persons have not been tested for HIV and a large population of individuals with HIV infection are unaware of their status. Failed early detection of HIV infection prevents any possible early educational interventions or behavior modification and precludes pre-AIDS treatment with highly active antiretroviral therapy. Aggressive antiretroviral treatment can significantly improve clinical and health status and reduce viral load, which may diminish patient infectivity and potentially interrupt any future transmission. Continued high-risk behavior among persons with unrecognized and untreated HIV infection promotes transmission of the virus.

Because few studies have examined the level of early detection actually achieved in a community, the authors attempted to assess the frequency and factors associated with early HIV detection in persons diagnosed with AIDS in Los Angeles County, Calif. The sample selected included persons ages 18 and older who have been diagnosed with AIDS and reported to the Los Angeles County AIDS Surveillance Registry. Between January 1997 and June 2002, participants were asked about demographic and socioeconomic characteristics, sexual and drug use risk behaviors, date of first positive HIV test, reasons for HIV testing, and access to medical and social services. Early detection was defined as greater than 5 years between first reported positive HIV test and AIDS diagnosis.

A total of 1,469 persons were interviewed between January 1997 and June 2002, representing 48 percent of the persons targeted for enrollment. The analysis was limited to 1,268 persons who reported a month and year for their first positive HIV test. The population was predominantly male (81 percent) and was racially diverse with whites constituting 18 percent, blacks 23 percent, Latinos 55 percent, and Asians/others 4 percent of the sample. Almost half of the participants reported male-male sex (49 percent), 12 percent were injection drug users, and 20 percent had reported heterosexual mode of transmission. More than half (59 percent) of persons interviewed stated that they had been tested for HIV because of illness; only 9 percent reported being tested because they felt that they were at risk.

Over the study period, 20 percent (253/1,268) of persons interviewed met the criterion for early detection while 52 percent tested positive for HIV within 3 months of an AIDS diagnosis. Early detection was more common in males (21 percent) than females (14 percent); among whites (40 percent) than blacks (24 percent), US-born Latinos (16 percent), and foreign-born Latinos (10 percent); among MSM (25 percent), IDU (22 percent), and MSM/IDU (36 percent) than persons who reported heterosexual transmission (12 percent). After controlling for gender, race/ethnicity, and age at AIDS diagnosis, women, blacks, US-born Latinos, foreign-born Latinos, persons less than 30 years old at AIDS diagnosis, and persons who reported heterosexual risk were less likely to meet the early detection criterion. Early detection was significantly more common with MSM/IDU.

Although Los Angeles is an area of high HIV prevalence, the authors' findings indicate an overall low level of early HIV detection and suggest that major sociodemographic and risk group disparities exist in the probability of early HIV detection. These differences have important implications both for reducing the levels of community HIV transmission and for individual health.

Innovative approaches, including the use of oral-based tests and rapid testing, the availability of home collection kits, the implementation of broad-based inpatient and outpatient testing, and the establishment of community-based programs to increase awareness of risk and improve the acceptability of testing are warranted. Special efforts should be directed toward minorities, women, heterosexuals, younger age groups, and persons of lower income and educational levels. Links to treatment, with wide access to new therapies, and behavioral intervention programs to reduce HIV risk behaviors should accompany such expanded testing efforts.



 


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Information in this article was accurate in July 22, 2003. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.