title: Late diagnosis of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: role of socio-behavioral factors and medical encounters.
abstract: OBJECTIVE
  Despite provision of free-of-charge human immunodeficiency virus (HIV) care and antiretroviral therapy in Taiwan, a substantial proportion of patients experience late HIV diagnosis. We investigated the risk factors for late HIV diagnosis in Taiwan.
  
  
  METHODS
  Structured interviews were conducted among newly diagnosed HIV-infected patients to collect data on demographics, socio-behavioral variables and clinical profiles within 1 year preceding HIV diagnosis from August 2006 to July 2008. Multivariate analysis was performed to identify factors associated with missed opportunities for HIV testing and late HIV diagnosis (< 200 CD4 cells/μL).
  
  
  RESULTS
  Among 227 newly diagnosed HIV-infected patients, 107 (47%) had late HIV diagnosis. Patients who had first positive tests for HIV at voluntary testing sites [odds ratio (OR): 0.22; 95% confidence interval (CI): 0.10-0.50], regular sexual partners at HIV diagnosis (OR: 0.30; 95% CI: 0.14-0.68), and unprotected sex in the preceding 3 months (OR: 0.16; 95% CI: 0.07-0.34) were less likely to have late HIV diagnosis. Missed opportunities for HIV testing after seeking medical attention occurred in 47 patients (20.7%) and were more common in patients with late HIV diagnosis than in those who received an earlier diagnosis (23.0% vs. 15.8%, p = 0.03). Patients with late HIV diagnosis were more likely than their counterparts to have received a diagnosis of seborrheic dermatitis (7.4% vs. 0.8%, p = 0.02) and community-acquired pneumonia (5% vs. 0%, p = 0.02), for which HIV testing was not offered by the health care providers.
  
  
  CONCLUSIONS
  Late HIV diagnosis is not uncommon in Taiwan. Regular risk assessment and provision of routine HIV testing in medical encounters and increase of accessibility to voluntary HIV testing could facilitate earlier diagnosis of HIV infection.
authors.affiliation: Centers for Disease Control, Department of Health, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.forename: Chia-Yin
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Chen
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Szu-Min
authors.initials: SM
authors.lastname: Hsieh
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged