title: Lack of awareness in both patients and physicians contributes to a high rate of late presentation in a South West German HIV patient cohort.
abstract: OBJECTIVE
  To assess rate of late presentation with HIV in Southwestern Germany and to identify patient characteristics correlated with CD4 nadir.
  
  
  METHODS
  Patients with primary diagnosis who presented to one of ten participating clinics rated on knowledge and behavior towards HIV testing on a self-developed questionnaire, whereas clinical data was assessed by the physician.
  
  
  RESULTS
  161 patients were included. Risk factors were homosexual (59.5 %) or heterosexual contacts (26.8 %), drug use (2.0 %), migration (3.9 %), or others (7.8 %). 63.5 % had a CD4 T cell count < 350/µl. 52.5, 17.4, and 31.1 % were diagnosed in CDC stadium A, B or C, respectively. 209 disease episodes were reported, from whom 83.7 % had led to the diagnosis of HIV. 75.2 and 68.3 % said to have been well-informed about ways of transmission and testing offerings, respectively, and 20.4 % admitted to have psychologically repressed the possibility of being infected. 48 patients rated their personal behavioral risk as "high" or "very high". Of these, however, only ten had performed at test in the precedent year. Performing a regression analysis, younger age and previous testing were correlated with a higher CD4 T cell nadir (p = 0.005, and 0.018, resp.).
  
  
  CONCLUSIONS
  The rate of late presentation in this region was even higher compared to national or European surveys. Most infected patients perceived to have had only a low risk. Several disease episodes did not lead to the initiation of HIV testing by the physician.
authors.affiliation: 1st Medical Department, University Medical Centre Mainz, Langenbeckstr. 1, 55131, Mainz, Germany, jenskittner@yahoo.de.
authors.forename: J M
authors.initials: JM
authors.lastname: Kittner
authors.forename: L
authors.initials: L
authors.lastname: von Bialy
authors.forename: J
authors.initials: J
authors.lastname: Wiltink
authors.forename: T
authors.initials: T
authors.lastname: Thomaidis
authors.forename: B
authors.initials: B
authors.lastname: Gospodinov
authors.forename: A
authors.initials: A
authors.lastname: Rieke
authors.forename: F
authors.initials: F
authors.lastname: Katz
authors.forename: T
authors.initials: T
authors.lastname: Discher
authors.forename: K
authors.initials: K
authors.lastname: Rath
authors.forename: B
authors.initials: B
authors.lastname: Claus
authors.forename: G
authors.initials: G
authors.lastname: Held
authors.forename: G
authors.initials: G
authors.lastname: Friese
authors.forename: B
authors.initials: B
authors.lastname: Schappert
authors.forename: M
authors.initials: M
authors.lastname: Schuchmann
authors.forename: P R
authors.initials: PR
authors.lastname: Galle
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D010820:Physicians; D011361:Professional Competence