Delayed diagnosis of HIV infection in Victoria 1994 to 2006
Chris Lemoh A B C D E , Rebecca Guy B , Keflemariam Yohannes B , Jenny Lewis B , Alan Street C D , Bev Biggs A C D and Margaret Hellard B CA Department of Medicine, The University of Melbourne, 4th Floor, Clinical Sciences Building Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
B Centre for Epidemiology and Population Health Research, Burnet Institute, 85 Commercial Road, Vic. 3004, Australia.
C Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050, Australia.
D Centre for Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050, Australia.
E Corresponding author. Email: c.lemoh@pgrad.unimelb.edu.au
Sexual Health 6(2) 117-122 https://doi.org/10.1071/SH08028
Submitted: 11 April 2008 Accepted: 18 January 2009 Published: 18 May 2009
Abstract
Background: The identification of factors associated with delayed diagnosis of HIV infection in Victoria, Australia was the aim of the present study. Methods: Demographic and epidemiological characteristics of cases notified to the Victorian HIV surveillance database between 1 January 1994 and 31 December 2006 were analysed. Delayed diagnosis was defined as: CD4 count below 200 cells mm−3 at HIV diagnosis or diagnosis of AIDS earlier than 3 months after HIV diagnosis. Results: Diagnosis of HIV was delayed in 627 (22.6%) of 2779 cases. Of these, 528 (84.2%) had either a high-risk exposure or were born in a high-prevalence country. The most common exposure was male homosexual contact in 64.3% of cases. Independent risk factors for delayed diagnosis were: older age at diagnosis (30–39 years odds ratio [OR] 2.15, ≥ 50 years OR 7.50, P < 0.001), exposure via routes other than male homosexual sex or injecting drug use (heterosexual sex OR 2.51, P < 0.001, unknown/other route OR 4.24, P < 0.001); birth in Southern/Eastern Europe (OR 2.54), South-east Asia (OR 2.70) or the Horn of Africa/North Africa (OR 3.71, P < 0.001), and male gender (OR 0.47 for females, P < 0.001). Conclusion: Delay in the diagnosis of HIV infection is common in Victoria, but potentially avoidable in the majority of cases. Most people with delayed diagnosis had a history of male homosexual contact, injecting drug use, birth in a high-prevalence country or sexual contact with such individuals. An accurate sexual history, together with knowledge of their country of birth, should identify most individuals who should be offered an HIV test.
Additional keywords: AIDS, diagnostic errors, early diagnosis, CD4 lymphocyte count, sexual behaviour, public health, healthcare disparities, physician’s practice patterns, quality of health care, population characteristics.
Acknowledgements
The project was partly funded by the Victorian Government’s Department of Human Services. Margaret Hellard receives funding from the National Health and Medical Research Council (NHMRC) for a career development fellowship and VicHealth for a senior public health research fellowship. Chris Lemoh received a scholarship from the Centre for Clinical Research Excellence in Infectious Diseases. Beverley Ann Biggs received a Public Health Research Grant from the Victorian Government’s Department of Human Services.
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1 *Note: On 3 November 2008 Australian antiretroviral guidelines changed to recommend the use of HAART for asymptomatic HIV-infected individuals with a CD4 count between 200 and 350 cells µL−1 as well as those with a CD4 count below 200 cells µL−1. The updated guidelines are available from URL: http://www.ashm.org.au/uploads/DHHSAdult_10 31 08 - FINAL.pdf
