HIV/AIDS Research

Late diagnosis of HIV is a problem for older patients, many of whom aren't diagnosed until they've already developed AIDS

Late diagnosis of HIV infection is a substantial problem, especially for older patients. They are twice as likely as younger patients to have already developed AIDS by the time they are diagnosed with HIV infection, according to a study at Duke University. Individuals whose HIV infection is not diagnosed pose a risk to their sexual partners, and once it has progressed to AIDS (infection-fighting CD4 cells depleted to levels below 200 cell/uL), they do not benefit as much from highly active antiretroviral therapy (HAART).

The researchers studied patients (age 17-61 years) with newly diagnosed HIV infection, who were evaluated at the Duke University HIV clinic between 2002 and 2004. Nearly half (49 percent) of the patients already had developed AIDS at the time of HIV diagnosis. This was in stark contrast to the 12 percent diagnosed at this late stage of HIV disease reported a decade ago in South Carolina.

Older patients are twice as likely as younger patients to be diagnosed with AIDS and to be diagnosed during hospitalization. Women were nearly seven times as likely as men to be diagnosed during hospitalization. Older patients and women, as well as their providers, may perceive that they are at low risk of HIV infection, perhaps making them less likely to be tested. Also, the availability of HAART may reduce the sense of urgency with which people seek HIV testing today, explain the researchers.

Their findings support the recent call by the Centers for Disease Control and Prevention for routine, nationwide HIV testing in primary care settings. In line with recent trends, nearly two-thirds (63 percent) of patients diagnosed with HIV infection were minorities and over one-fourth (28 percent) contracted the infection through heterosexual contact. Eighteen percent of those studied had already developed an opportunistic infection such as Pneumocystis carinii pneumonia or Kaposi's sarcoma.

The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00079).

See "Late diagnosis of HIV infection: The role of age and sex," by Michael J. Mugavero, M.D., M.H.S., Chelsea Castellano, B.S., David Edelman, M.D., M.H.S., and Charles Hicks, M.D., in the April 2007 American Journal of Medicine 120, pp. 370-373.

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