title: Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study.
abstract: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV.
  
  
  
  A retrospective observational cohort study.
  
  
  
  A central tertiary medical centre in Israel.
  
  
  
  The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients.
  
  
  
  Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist.
  
  
  
  Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.|Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Itzchak
authors.initials: I
authors.lastname: Levy
authors.affiliation: Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.|Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.|Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Naim
authors.initials: N
authors.lastname: Mahroum
authors.affiliation: Unit of Biostatistics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Liraz
authors.initials: L
authors.lastname: Olmer
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Wieder
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Vladislav
authors.initials: V
authors.lastname: Litchevski
authors.affiliation: Central Virology Laboratory, Ministry of Health, National HIV Reference Laboratory, Tel Hashomer, Israel.|Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Mor
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel.|Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
mesh_terms: D000328:Adult; D000367:Age Factors; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: PRIMARY CARE; diagnosis; late detection