Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study.
OBJECTIVE
One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis.


METHODS
A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient's neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed.


RESULTS
The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2-0.8); Sub-Saharan Africa (SSA): 0.3 (0.2-0.6); other: 0.5 (0.2-1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1-1.0); SSA (0.4 (0.2-0.8)). The latter was also lower for men who have sex with men (0.5 (0.2-1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05.


CONCLUSIONS
Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.
Unit of Infectious Diseases, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Johanna
http://orcid.org/0000-0001-7684-8591
J
Brännström
Unit of Infectious Diseases, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Veronica
V
Svedhem
Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Gaetano
G
Marrone
Department of Infectious Diseases, Sundsvall County Hospital, Sundsvall, Sweden.
Örjan
Ö
Andersson
Department of Infectious Diseases, Gävle County Hospital, Gävle, Sweden.
Farshad
F
Azimi
Department of Clinical Science and Education, Venhälsan, Stockholm South General Hospital, Stockholm, Sweden.
Anders
A
Blaxhult
Unit of Infectious Diseases, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
Anders
A
Sönnerborg
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000276:immunology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003710:Demography; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006268:Health Facilities; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D012307:Risk Factors