One in three patients diagnosed with low CD4 cell count in UK and Ireland

A third of new HIV diagnoses in the UK and Ireland involve individuals with advanced immune suppression, according to a study published on May 13^th in the on-line edition of the British Medical Journal. The investigators also found that a significant number of newly diagnosed individuals had contacted a healthcare provider in the twelve months before their HIV diagnosis with symptoms suggestive of HIV infection.

“We found a significant number of missed opportunities for earlier diagnosis of HIV infection,” write the investigators.

Initial findings from the analysis were presented to the 2003 conference of the British HIV Association and reported here on aidsmap.

In 2001, almost 60% of individuals who started HAART had a CD4 cell count below 200 cells/mm³. The main reason for the delayed initiation of antiretroviral therapy was a late diagnosis of HIV.

Investigators wished to determine the proportion of patients newly diagnosed with HIV with a CD4 cell count below 200 cells/mm³, the features of these patients, and if these individuals had been in contact with health services prior to their diagnosis with symptoms suggestive of HIV.

Data were gathered using a national case review. A total of 148 HIV treatment centres in the UK and Ireland were asked to provide details of new HIV diagnoses made in the first three months of 2003. A total of 113 centres provided data on 977 individuals.

A total of 301 (33%) individuals had their HIV diagnosed when their CD4 cell count was already below 200 cells/mm³, and this was significantly more likely to occur in older patients (p = 0.0001), and black Africans (p = 0.03). Late diagnosis was, however, less frequent amongst gay men, irrespective of their age or ethnicity (p = 0.07).

HIV was diagnosed as part of a general screen in 401 (41%) of patients. This was associated with being younger, black African and heterosexual. Diagnosis in a sexual health setting was made for 664 (68%) patients, and these individuals were more likely to be young, male and gay, and less likely to be black African. After adjusting for demographics, diagnosis in both sexual health setting (p = 0.001) and as part of a routine screen (p = 0.0001) were significantly associated with a lower chance of having a CD4 cell count below 200 cells/mm³ at the time of diagnosis.

In the twelve months before HIV diagnosis, 168 patients (17%) had a clinical episode that was likely to be HIV related. These included 58 hospital admissions (including 18 for tuberculosis).

“This study provides further evidence of late diagnosis of HIV infection, reflecting national trends reported by the Health Protection Agency,” note the investigators, who emphasise the benefits in terms of cost, public health and the health of the individual in terms of early diagnosis of HIV.

The investigators conclude, “improving the offering and uptake of HIV testing both as part of routine screening and as indicated by associated medical conditions should reduce the number of undiagnosed HIV infections.”