Late diagnosis of Human Immunodeficiency Virus (HIV) increases the risk of new transmission, Acquired Immune Deficiency Syndrome (AIDS), and AIDS-related deaths. Late HIV diagnosis is also thought as a major impediment for the success of Antiretroviral Therapy (ART) outcomes. In the United States in 2014, about one-quarter of HIV infections were diagnosed late and simultaneously with AIDS. South Carolina (SC), a rural southern state, is among the nation’s top in HIV incidence and also exhibits a very high rate of late HIV diagnosis. This study investigates prevalence, causes, and consequences of late HIV diagnosis in SC.
Using statewide surveillance data from patients diagnosed with HIV in the period 1997-2013, Late diagnosis of HIV infection was defined as stage 3 (AIDS) based on CD4 count 200 cells/mL and/or opportunistic illness within 3 months of HIV diagnosis. Logistic regression approach is used to identify the patient groups susceptible to late diagnosis. A Bayesian joint analysis is used to model the differentials in viral load, CD4 cell count, and death risk as consequences of late diagnosis. All statistical analyses have been performed after controlling for patient demographics and treatment information and statistical significance were reported at 5% level.
The proportion of late HIV diagnosis declined from 61.6% in 1997 to 38.7% in 2013. However, the rate of late diagnosis in SC is still alarming and higher than many other states in the country. Male, non-White, and older patients exhibited higher odds of late diagnosis. After adjusting for demographic and treatment characteristics, the joint model analysis revealed that the patients diagnosed late were able to maintain lower viral loads even when compared to early diagnosed patients. However, late diagnosis made them highly vulnerable to have poor CD4 count and put them at about 70% high risk of death.
From early diagnosis of HIV infection, both the patient and the society can be benefited. The findings from this study can help devising policy strategies to implement targeted intervention and spread awareness to reduce late diagnosis after HIV infection in SC.
J. Osterman, None
H. Chakraborty, None
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