title: [Late diagnosis of HIV positive patients in Rotterdam, the Netherlands: risk factors and missed opportunities].
abstract: OBJECTIVE
  To determine the percentage of patients in whom the diagnosis 'HIV infection' was made late, which factors are associated with an increased risk of a late HIV diagnosis, and if there are opportunities for an earlier diagnosis.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  We included all HIV positive patients who were treated at the Erasmus Medical Center Rotterdam in the period January 1996-March 2012. We divided these patients into two groups: patients with a timely diagnosis and patients with a late diagnosis (CD4+ T cell count < 350/mm3). We performed a structured interview in patients who were diagnosed in the period January 2009-March 2012. To determine possible risk factors for a late diagnosis we used univariate and multivariate analyses.
  
  
  RESULTS
  A late diagnosis 'HIV infection' was made in 59% of the 2256 patients. Independent patient characteristics associated with a late diagnosis were heterosexual transmission (odds ratio (OR): 1.87; 95% CI: 1.44-2.43; p < 0.001), age > 50 years (OR: 1.73; 95% CI: 1.28-2.34; p < 0.001), and a Sub-Saharan African (OR: 1.66; 95% CI: 1.02-2.71; p = 0.043) or Asian origin (OR: 2.31; 95% CI: 1.20-4.43; p = 0.012). The interviews showed that more than 75% of patients with a late HIV diagnosis were already known with a risk factor for HIV, according to the STD practice guideline from the Dutch College of General Practitioners.
  
  
  CONCLUSIONS
  In the past 15 years, 59% of HIV positive patients in Rotterdam presented late. This mainly concerned patients older than 50 years and immigrants originating from HIV endemic areas. It is important to prevent a late diagnosis, as this can lead to poorer response to combination antiretroviral therapy and higher mortality.
authors.affiliation: Erasmus MC, afd. Inwendige Geneeskunde-Infectieziekten, Rotterdam, the Netherlands.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: Schouten
authors.forename: A J Rianne
authors.initials: AJ
authors.lastname: van Velde
authors.forename: Ingrid J M
authors.initials: IJ
authors.lastname: Snijdewind
authors.forename: Annelies
authors.initials: A
authors.lastname: Verbon
authors.forename: Bart J A
authors.initials: BJ
authors.lastname: Rijnders
authors.forename: Marchina E
authors.initials: ME
authors.lastname: van der Ende
mesh_terms: D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors