Two Decades of Late Diagnosis in HIV Infection: An Observational and Retrospective Study in a District Hospital

Background: Portugal has one of the highest incidence rates of HIV and AIDS and one of the highest percentages of late diagnosis in the European Union. Objectives: Evaluation of late diagnoses between 1998-2018. Comparison of demographic, epidemiological and mortality data. Identification of risk factors to very late presentation. Methods: Retrospective study of HIV patients with 1st visit between 1998-2018, divided into groups A: Lymphocyte TCD4+ count (TCD4+) <200 cells/ l; B: TCD4+ 200-350 cells/ l. Statistical analysis by Statistical Package for the Social Sciences® (SPSS) 24.0. Results: From the data base, 613 patients met the TCD4+ cell count, but only 48% (n=533) fulfilled all inclusion criteria 65.5% of which (n=349) in group A. Group analysis (A vs. B): Male predominance 80.2% vs. 67.4% (p=0.001); age at 1st visit >40 yrs. 52.4% vs. 35.9% (p=0.001) increasing with time (p<0.001); heterosexual risk 55.3% vs. 52.7%, increasing with time (p<0.001); intra-hospital referral 50.4% vs.23.9% (p<0.001). Between-group comparison: 66.2% vs. 31.0% (p<0.001) had an AIDS- defining illness, most frequently tuberculosis (19.5% vs. 17.9%). The risk factors for presentation with advanced disease found in this study, which were the male gender, age >40 years (particularly in men) and in-hospital diagnosis, suggests that this subgroup failed all the screening opportunities thus far.Mortality rate was higher in Group A (28.7%, p=0.020), with a lower survival time (1828 [433-3675] days, p=0.008). Conclusion: Risk factors for very late presentation (TCD4+ <200 cells/ l) are as follows: Male gender (OR=2.00, CI 95% 1.25 to 3.20, p=0.004), age over 40 yrs. (OR=1.79, 95% CI 1.19 to 2.71, p=0.006) and intra-hospital diagnosis (OR=3.16, CI 95% 2.10 to 4.76, p<0.001). The increase in risk over 40 yrs was not observed in women (OR=0.90, CI 95% 0.40 to 2.07, p=0.809). These results support the importance of early HIV diagnosis, with implications in global outcome and public health.