Missed opportunities for earlier diagnosis of HIV in patients that presented with advanced HIV disease: a retrospective cohort study

OBJECTIVE: To quantify and characterize missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical center in Israel. MEASURES: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients RESULTS: Between 2010-2015, 356 patients were diagnosed with HIV, 118 (33.4 %) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 [95% CI 1.16-1.74]) and being heterosexual (OR=2.65 [95% CI 1.21-5.78]) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 month (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist.
CONCLUSIONS: Misse...