Data from: 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:
Missed opportunities to early diagnosis of HIV occur both in primary and
secondary care. Lack of national guidelines, lack of knowledge regarding
CIDs and communication barriers with patients may contribute to HIV late
diagnosis. 'Strengths and limitations of this study' This study
shows for the first time rate and reasons for missed opportunities to
diagnose HIV in a low prevalence country like Israel. This study may shed
light on the reasons why primary care physicians or specialists are
missing to diagnose HIV earlier. Nonexistence of clear national guidelines
for HIV testing and ignoring HIV clinically indicator diseases are major
reasons for missed diagnosis of HIV. This study was carried out in one
center and may not reflect the picture in the all country; Also, the total
number of patients is low and this may limit generability of the study