title: Associations of HIV testing and late diagnosis at a Japanese university hospital.
abstract: OBJECTIVE
  This study was conducted to clarify the rate of late diagnosis of HIV infection and to identify relationships between the reasons for HIV testing and a late diagnosis.
  
  
  METHODS
  This retrospective cohort study was conducted among HIV-positive patients at the Jikei University Hospital between 2001 and 2014. Patient characteristics from medical records, including age, sex, sexuality, the reason for HIV testing and the number of CD4-positive lymphocytes at HIV diagnosis, were assessed.
  
  
  RESULTS
  A total of 459 patients (men, n=437; 95.2%) were included in this study and the median age at HIV diagnosis was 36 years (range, 18-71 years). Late (CD4 cell count <350/mm3) and very late (CD4 cell count <200/mm3) diagnoses were observed in 61.4% (282/459) and 36.6% (168/459) of patients, respectively. The most common reason for HIV diagnosis was voluntary testing (38.6%, 177/459 patients), followed by AIDS-defining illness (18.3%, 84/459 patients). Multivariate analysis revealed a significant association of voluntary HIV testing with non-late and non-very-late diagnoses and there was a high proportion of AIDS-defining illness in the late and very late diagnosis groups compared with other groups. Men who have sex with men was a relative factor for non-late diagnosis, whereas nonspecific abnormal blood test results, such as hypergammaglobulinemia and thrombocytopenia, were risk factors for very late diagnosis.
  
  
  CONCLUSIONS
  Voluntary HIV testing should be encouraged and physicians should screen all patients who have symptoms or signs and particularly hypergammaglobulinemia and thrombocytopenia, that may nonspecifically indicate HIV infection.
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horino
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Fumiya
authors.initials: F
authors.lastname: Sato
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Hosaka
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Tokio
authors.initials: T
authors.lastname: Hoshina
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakaharai
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakazawa
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshikawa
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Tokyo, Minato-ku, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Hori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis*; D015438:Health Behavior; D006785:Hospitals, University; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood*; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000150:complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood; D055815:Young Adult