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Background: The
undiagnosed HIV infection is globally recognized as a serious problem because
it may be spread and lead to morbidity decades after HIV infection with either
an AIDS-defining illness or HIV-related deaths. In response to sustained high
levels of undiagnosed HIV infections across Europe and high number of patients
diagnosed with AIDS, we make an assessment of incidence and factors associated
with late vs. early HIV diagnosis in Poland.
Methods: In
present study we retrospectively analyses prevalence of late diagnosis among
newly diagnosed patients referred to eight regional HIV treatment centres in
Poland in years 2006-2008. The study population consisted of 1132 HIV-infected
Caucasian patients newly diagnosed with HIV infection, aged 17 years up.
To describe characteristics of this group of patients in
terms of clinical and immunological presentation multivariate regression
analysis of demographic and epidemiology data including: sex, age, mode of
transmission, CD4 count and viral load at the time of diagnosis was performed.
Results: Five hundred four patients (49.8%) were late presenters (LP) according to European consensus definition. The groups with the highest rate of late presentation were IDUs (59.2%) and Hx (60.7%). LP was also more frequent among female patients (55%). In multivariate logistic analysis age (OR=1.06), intravenous drug use (OR=2.17 for IVDU vs. MSM) and heterosexuality (OR=2.07 for Hx vs. MSM) were independent risk factors for late testing. The same factors were predictors of advanced HIV disease, as well as unknown route of infection (OR=1.77; p<0.05). Only advanced age was an independent factor influencing lower CD4 count and late presentation (OR=1.02 per 1 year of age, p<0.001).
Conclusion: These
results strongly point out necessity of initiated testing among intravenous
drug users, heterosexual women and older patients.
On basis of presented study it seems that the most important
task for future seems to be the matter of recognizing indicator conditions and
groups not traditionally perceived as high-risk.
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