DELAY IN DIAGNOSIS AMONG AIDS-PRESENTER IN TWO HOSPITALS IN THE NORTH EAST OF ITALY

Introduction. Most common causes of death in HIV patients in high income countries are related to late presentation (LP), defined as presenting for care with a CD4 count <350 cell/µL or with an AIDS-defining event. Data by ECDC illustrate that during years 2008-2012 in Italy, 5382 AIDS cases occurred with 2307 AIDS-related death. LP is associated to reduced life expectancy, higher risk of HIV transmission and economic implications. In this preliminary study we aimed to calculate the delay in HIV diagnosis in patients with symptoms of AIDS-disease and to characterize AIDS-events more frequently related to delay. Methods We retrospectively analyzed data of patients with new HIV diagnosis and less than 350 T-CD4 cells/µL in period 2008-13 in Rovigo and Ferrara hospitals; furthermore, we calculated the days between the first contact with any health care provider because of onset of AIDS-disease symptoms and diagnosis of HIV/AIDS. We also evaluated risk factors for delay in diagnosis. Results. An overall of 233 new diagnoses was recorded by the two centers and 47.6% were LP. Of these, 33.3% were AIDS-presenter and 7.2% died. Median age of LP was 43 ys (IQR 35-52); 72.1% males; 18.9% non-nationals. Risk factors related with HIV transmission were HET 55% (n.45), MSM 18.9% (n.12), IDU 5.4% (n.3), unknown, 20.7% (n. 18). Among 37 AIDS-presenters (M 76%, F 24%; HET 60%, MSM 16.5%, unknown, 23.5%), we recorded the following AIDS events: 10 wasting syndromes, 9 PCP, 7 esophageal candidiasis, 6 Kaposi’s Sarcoma (KS), 5 CMV disease, 3 neurotoxoplasmosis (NT), 3 Non Hodgkin Lymphomas, 3 Progressive Multifocal Leukoencephalopathy, 2 TB, 1 AIDS dementia complex (ADC), 1 Atypical mycobacteriosis, 1 Candida pneumonia, 1 Cryptococcosis*. Of these patients, 24,5% had more than 1 AIDS event at diagnosis. We found a median delay of 48,5 days (IQR 16-154), which was maximum in patients with (180 days) and KS (150 d) and minimum in those with NT, (10 d) and TB (9 d). Mortality among AIDS presenters was 23%. There were no significant differences in delay of diagnosis between national and non-national, male and female and risk factors. Conclusions In our centers, LP demographic features agree with national data. Despite the presence AIDS events, HIV test was performed with a median delay of more than 45 d; some conditions such as ADC or KS were associated with a lateness of 6-5 months respectively. By contrast, TB seemed to be linked with a quicker HIV-test performance, probably due to physicians’ awareness of the epidemiological relevance of coinfection TB-HIV. Typical AIDS events, as KS and esophageal candidiasis, were associated with a relevant delay. “Late testing” even in presence of an AIDS event shows how nowadays HIV is a less perceived issue. Our study points out the need of improving physicians’ consciousness about AIDS to detect it and starting HAART together with other specific therapy as soon as possible.