Late diagnosis of HIV infection: major consequences and missed opportunities.

The availability of highly active antiretroviral therapy (HAART) has transformed the outcome for individuals with diagnosed HIV infection where access to therapy is widely available. There continues to be significant (although markedly reduced) ongoing morbidity and mortality despite HAART, however. Although this may result from resistance to available antiretroviral therapies or treatment refusal, a recent audit of deaths in HIV-positive individuals in the UK demonstrated that the commonest reason for HIV-related death was that HIV had been diagnosed too late for effective intervention [1]. Anonymous seroprevalence studies suggest that approximately one in three individuals with HIV infection in developed countries are unaware of their infection [2,3], with much higher rates in developing countries where rollout programmes are currently underway [4]. If the benefits of HAART are to be fully realized, then not only is availability crucial but also those individuals who require treatment must be appropriately identified.

[1]  J. Sterne,et al.  Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies , 2007, AIDS.

[2]  F. Lert,et al.  Correlates of late HIV diagnosis: implications for testing policy , 2007, International journal of STD & AIDS.

[3]  Andrew T. Kroger,et al.  General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2006, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[4]  K. D. de Cock,et al.  HIV prevention for a threatened continent: implementing positive prevention in Africa. , 2006, JAMA.

[5]  Christopher D Pilcher,et al.  Three- vs four-drug antiretroviral regimens for the initial treatment of HIV-1 infection: a randomized controlled trial. , 2006, JAMA.

[6]  G. Marks,et al.  Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA , 2006, AIDS.

[7]  A. Blaxhult,et al.  Patients unaware of their HIV infection until AIDS diagnosis in Sweden 1996-2002--a remaining problem in the highly active antiretroviral therapy era. , 2005, International journal of STD & AIDS.

[8]  J. Castilla,et al.  Effectiveness of Highly Active Antiretroviral Therapy in Reducing Heterosexual Transmission of HIV , 2005, Journal of acquired immune deficiency syndromes.

[9]  Gary Marks,et al.  Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They are Infected With HIV in the United States: Implications for HIV Prevention Programs , 2005, Journal of acquired immune deficiency syndromes.

[10]  C. Sabin,et al.  Newly diagnosed HIV infections: review in UK and Ireland , 2005, BMJ : British Medical Journal.

[11]  C. Sabin,et al.  Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy , 2004, AIDS.

[12]  G. Ippolito,et al.  Delayed Presentation and Late Testing for HIV: Demographic and Behavioral Risk Factors in a Multicenter Study in Italy , 2004, Journal of acquired immune deficiency syndromes.

[13]  M. Gill,et al.  The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection , 2004, HIV medicine.

[14]  J. Kaldor,et al.  Late HIV presentation among AIDS cases in Australia, 1992–2001 , 2003, Australian and New Zealand journal of public health.

[15]  L. de la Fuente,et al.  Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence , 2002, AIDS.

[16]  G. Cornah.  The department of health , 1974, Postgraduate medical journal.

[17]  Late versus early testing of HIV--16 Sites, United States, 2000-2003. , 2003, MMWR. Morbidity and mortality weekly report.