title: Late HIV presentation: epidemiology, clinical implications and management.
abstract: Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.
authors.affiliation: St Stephens Research, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Waters
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000821:virology*; D057210:Delayed Diagnosis; D019468:Disease Management; D018450:Disease Progression; D024882:Drug Resistance, Viral / Q000187:drug effects; D006678:HIV / Q000187:drug effects / Q000502:physiology*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000473:pathology / Q000821:virology; D006801:Humans; D011159:Population Surveillance; D011634:Public Health; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents