naa a22 4500 510740588 CHVBK 20180411083026.0 cr unu---uuuuu 180411e20130901xx s 000 0 eng 10.1007/s11845-012-0898-2 doi (NATIONALLICENCE)springer-10.1007/s11845-012-0898-2 Late presentation of HIV despite earlier opportunities for detection, experience from an Irish Tertiary Referral Institution [Elektronische Daten] [O'Shea. D, M. Ebrahim, A. Egli, D. Redmond, S. McConkey] Objectives: Late presentation of HIV continues to undermine advances in the management of HIV. Opportunities to detect HIV at an earlier stage are often missed. Current estimates suggest that undiagnosed individuals comprise approximately one quarter of all people in the western world living with HIV. ‘Testing-and-treating' this group has been proposed as a means to curb the HIV epidemic. In this study we assessed the characteristics of individuals newly diagnosed with HIV, and their utilisation of healthcare services in Ireland prior to their diagnosis. Methods: A retrospective review was undertaken of all patients newly diagnosed with HIV over a 27-month period. Patient demographics were recorded, as were details of healthcare contacts in the year preceding diagnosis. Individuals detected via screening of recent immigrants/asylum seekers were excluded. Results: In the period studied 114 patients received a new diagnosis of HIV, 59 met inclusion criteria. The majority (54%) fulfilled the European consensus definition for late presenters (CD4<350 cells/µl). ‘Late presenters' were significantly more likely to be symptomatic at diagnosis (OR=4.62; 95% CI 1.45-14.67; p=0.015), diagnosed by acute tertiary hospital services (p=0.015), and 56% reported heterosexual mode of acquisition (OR=2.12; 95% CI 0.73-6.16; p=0.19). Patients detected via screening had significantly higher CD4 counts at diagnosis compared with those diagnosed due to symptoms (Median CD4 422 cells/µl; IQR 285-594 vs. 142 cells/µl; IQR 62-333; p=0.0007). ‘Symptomatic' patients were significantly more likely to report prior healthcare contacts (OR 4.71; 95% CI 1.32-16.79; p=0.013). Conclusion: Current screening activities are inadequate. Unfortunately newly diagnosed HIV patients continue to be symptomatic, at advanced stages of disease, to acute hospital services. Heterosexual groups in particular are at risk for late detection. Royal Academy of Medicine in Ireland, 2013 HIV nationallicence Late presenters nationallicence Missed diagnostic opportunities nationallicence HIV screening nationallicence D O'Shea Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut Ebrahim M. Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland aut Egli A. Alberta Transplant Institute, Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada aut Redmond D. Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut McConkey S. Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 389-394 0021-1265 182:3<389 2013 182 11845 https://doi.org/10.1007/s11845-012-0898-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11845-012-0898-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- D O'Shea Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut NATIONALLICENCE 700 1- Ebrahim M. Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland aut NATIONALLICENCE 700 1- Egli A. Alberta Transplant Institute, Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Redmond D. Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut NATIONALLICENCE 700 1- McConkey S. Department of Infectious Diseases and Tropical Medicine, Beaumont Hospital, Dublin 9, Ireland aut NATIONALLICENCE 773 0- Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 389-394 0021-1265 182:3<389 2013 182 11845 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer