AEGiS-14IAC: A five-year review of medical encounters prior to the diagnosis of HIV (the HEDS UP study): implications for early detection strategies.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

A five-year review of medical encounters prior to the diagnosis of HIV (the HEDS UP study): implications for early detection strategies.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. LbPeD9038)

Klein D, Hurley L, Merrill D, Quesenberry C, Allerton M
Kaiser Permanente, Hayward, United States

BACKGROUND: HIV infection is now a treatable chronic condition. Early detection can improve prognosis and reduce transmission, but 30-40% of cases are diagnosed with advanced immunodeficiency. This study was designed to evaluate whether medical encounters in the five years prior to a diagnosis of HIV infection represent an opportunity to raise mean CD4 at diagnosis, and explore what other factors might be employed in early detection strategies.

METHODS: We conducted a retrospective review of patient medical records to examine medical encounters in the five years prior to diagnosis among all members of a large, multi-site closed system, managed care organization, diagnosed with HIV in 1998. Main outcome measures were CD4 cell count at diagnosis, documentation of HIV risk factors and HIV-related clinical events prior to diagnosis, and circumstances of diagnosis.

RESULTS: Among 440 patients, 43% had immunologic AIDS at diagnosis (mean 310, 18% <50). 61% of patients had clinical indicators of HIV prior to diagnosis; but only 22% had them over one year prior. 86% of patients had high risk, but only 26% had risks noted over one year prior. In multiple logistic regression, patients with undocumented risks (OR 2.0; CI 1.1, 3.5), or clinical indicators >1 year prior to diagnosis (OR 2.6; CI 1.3, 4.9), or <=1 year prior (OR 3.6; CI 2.0, 6.4) had increased odds of having a CD4 < 200 at diagnosis. Conversely, younger (OR 1.05; CI 1.02, 1.08; per year), and female (OR 0.3; CI 0.1, 0.7) patients, those previously testing HIV-negative (OR 0.4; CI 0.2, 0.7), and those who requested testing (OR 0.5; CI 0.3, 0.8) had lower odds.

CONCLUSIONS: Even with good access to care, early detection of HIV remains a challenge. In this setting, increased risk assessment and more widespread patient-readiness to test appear more likely to improve early detection than does increased attention to clinical indicators.

Keywords: AEGIS, HIV Infections, HIV Seropositivity, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome, Prognosis, Time, Retrospective Studies, Female, Human, diagnosis

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