Late diagnosis of HIV infection: a challenge to healthcare providers and policy makers in a country with universal access to antiretroviral therapy
D. Fontenelle dos Santos, C. Santos Lima, T. Loja, I. Souza, M.C. Pacheco
State University of Rio de Janeiro, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
Background: Despite the universal access to antiretroviral therapy since 1996, the diagnosis of HIV infection is still delayed in Brazil. Many studies have proven that late stage diagnosis is associated with increased risk of death and more expenses with healthcare.
Methods: We conducted a retrospective review of 35 patients newly diagnosed with HIV during hospitalization at Pedro Ernesto University Hospital from State University of Rio de Janeiro (Brazil). Late diagnosis was defined by the identification of Aids associated diseases during hospitalization or CD4 cell count < 200 cells/mm3.
Results: The majority of this patients were male (63%) and 71% aged 30-49 years. At the time of diagnosis of HIV infection 54% had oral/esophageal candidiasis, 29% had Mycobacterium tuberculosis infection, 28% had respiratory symptoms, 25% had cerebral toxoplasmosis and 68% had others symptoms like fever, weight loss and diarrhea. All this pacients have been attended at outpacient clinics before the hospitalization at this hospital. Nine patients(25%) have evolved to death during the same hospitalization that they have the diagnosis of HIV infection.
Conclusions: Delayed diagnosis is critical from both clinical and public health perspectives. It is imperative to promote access to counseling and voluntary testing in order to improve timely diagnosis of HIV infection. Many healthcare providers have deficiency in clinical suspicion of HIV infection and fail to offer HIV tests to achieve earlier diagnosis. It´s also important that policy makers integrate HIV prevention and care and treatment programmes so that deaths could be avoided by reducing late infection diagnosis rates.
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