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Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

OBJECTIVE: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical centre in Israel. MEASURES: The proportion of patients with advanced HIV, the propor...

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Autores principales: Levy, Itzchak, Maor, Yasmin, Mahroum, Naim, Olmer, Liraz, Wieder, Anat, Litchevski, Vladislav, Mor, Orna, Rahav, Galia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129188/
https://www.ncbi.nlm.nih.gov/pubmed/28186940
http://dx.doi.org/10.1136/bmjopen-2016-012721
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author Levy, Itzchak
Maor, Yasmin
Mahroum, Naim
Olmer, Liraz
Wieder, Anat
Litchevski, Vladislav
Mor, Orna
Rahav, Galia
author_facet Levy, Itzchak
Maor, Yasmin
Mahroum, Naim
Olmer, Liraz
Wieder, Anat
Litchevski, Vladislav
Mor, Orna
Rahav, Galia
author_sort Levy, Itzchak
collection PubMed
description OBJECTIVE: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical centre in Israel. MEASURES: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. RESULTS: Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10–30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS: Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
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spelling pubmed-51291882016-12-08 Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study Levy, Itzchak Maor, Yasmin Mahroum, Naim Olmer, Liraz Wieder, Anat Litchevski, Vladislav Mor, Orna Rahav, Galia BMJ Open HIV/AIDS OBJECTIVE: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical centre in Israel. MEASURES: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. RESULTS: Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10–30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS: Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV. BMJ Publishing Group 2016-11-10 /pmc/articles/PMC5129188/ /pubmed/28186940 http://dx.doi.org/10.1136/bmjopen-2016-012721 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle HIV/AIDS
Levy, Itzchak
Maor, Yasmin
Mahroum, Naim
Olmer, Liraz
Wieder, Anat
Litchevski, Vladislav
Mor, Orna
Rahav, Galia
Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title_full Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title_fullStr Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title_full_unstemmed Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title_short Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study
title_sort missed opportunities for earlier diagnosis of hiv in patients who presented with advanced hiv disease: a retrospective cohort study
topic HIV/AIDS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129188/
https://www.ncbi.nlm.nih.gov/pubmed/28186940
http://dx.doi.org/10.1136/bmjopen-2016-012721
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