Methods: A retrospective cohort of all patients living with HIV who are receiving ART at Roosevelt Hospital was assembled. Charts were analyzed for clinical and demographic data. A survey was administered to those who consented regarding their previous healthcare exposure, specifically location of care, presenting symptoms and eventual diagnosis at those visits. AIDS was defined as a CD4 count less than 200 cells/mm³ or a presence of an AIDS Defining Illness (ADI) by the CDC definitions. Data was analyzed for trends.
Results: 3,654 patients were enrolled in the study and had the survey administered. 1,681 (46%) met the definition of AIDS at the time of diagnosis. Of those, 665 (18.2%) had sought healthcare in the 2 preceding years, with a median of 1 visit (range 1-10). However, 295/665 (44.3%) had multiple visits during which HIV infection was not considered. These patients were more commonly (68.7%) seen in private clinics, where their predominant symptoms were weight loss (73.8%), fever (63.8%), diarrhea (57.1%) and vomiting (30.5%). The predominant diagnoses given to patients were: intestinal parasites (12.4%), stomach virus (9.5%) and common cold (8.9%).
Conclusion: This is the first analysis from Latin America of missed opportunities for diagnosis of HIV in the general population. These data suggest that if the epidemic of HIV is to be halted in countries like Guatemala, routine screening will need to be employed as symptom-based diagnosis will miss 81.8% of all patients who eventually present with AIDS. However, if a targeted approach is to be employed, it should be geared towards patients presenting with weight loss, fever and gastrointestinal symptoms.
A. Alonzo, None
W. Powderly, None
C. Mejia, None