ABSTRACT
Fundamento: Analizar el porcentaje de pacientes con diagnóstico tardío (DT) de infección por VIH, sus factores de riesgo y las oportunidades perdidas para un diagnóstico más precoz. Material y métodos: Se incluyó a 165 pacientes diagnosticados de infección por VIH entre 2009 y 2013 en Navarra. Mediante regresión logística se estudiaron los factores asociados con DT (CD4 <350 células/mm3 o enfermedad definitoria de sida al diagnóstico). Se analizó la presencia de factores de riesgo e indicadores clínicos de una posible infección por VIH en los 5 años previos al diagnóstico. Resultados: La prevalencia global de DT fue del 55% (90/165). Este porcentaje fue mayor en los pacientes inmigrantes que en los españoles, y en aquellos sin serología realizada previamente. Se observó una interacción entre la edad y el origen del paciente. En los españoles el riesgo de DT aumentó con la edad a partir de los 40 años (OR: 3,72; IC95%: 1,52-9,12) pero esto no ocurrió en los inmigrantes. De los 132 pacientes con atención médica en los años previos al diagnóstico, 20 (15%) tenían factores de riesgo clásicos documentados en la historia, 14 (11%) procedían de regiones con alta prevalencia de VIH y 46 (35%) habían presentado indicadores clínicos sin la realización de la serología. Conclusiones: A pesar de los múltiples contactos con nuestro sistema sanitario, más de la mitad de los nuevos diagnósticos de infección por VIH se realizan tarde. Es necesario una mayor atención a los signos clínicos de la infección y, sobre todo, una mejor valoración del riesgo en pacientes asintomáticos (AU)
Background: To analyse the percentage of patients with a late diagnosis (LD) of HIV infection, their risk factors and the missed opportunities for an earlier diagnosis. Methods: One hundred and sixty-five patients diagnosed with HIV infection in Navarre between 2009 and 2013 were included. Logistic regression was used to study the factors associated with LD (CD4 <350 cells/ mm3 or AIDS defining disease at diagnosis). The presence of risk factors and clinical indicators of possible HIV infection in the 5 years preceding the diagnosis were analyzed. Results: The global prevalence of LD was 55% (90/165). This percentage was greater in immigrant patients than in Spanish patients, and in those without previous serology tests. An interaction was observed between the age and origin of patients. In Spaniards the risk of LD rose with age after 40 years (OR: 3.72; 95%CI: 1.52-9.12) but this did not occur in immigrant patients. Of the 132 patients who had received medical care in the years prior to diagnosis, 20 (15%) had classical risk factors recorded in their history, 14 (11%) proceeded from regions with a high prevalence of HIV, and 46 (35%) had presented clinical indicators without a serology test being realized. Conclusions: In spite of multiple contacts with our health system, over half of the new cases of HIV infection are diagnosed late. Greater attention to clinical signs is needed and, above all, a better evaluation of the risk in asymptomatic patients (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Delayed Diagnosis/statistics & numerical data , HIV Infections/diagnosis , Risk Factors , HIV Infections/epidemiology , Retrospective StudiesABSTRACT
BACKGROUND: To analyse the percentage of patients with a late diagnosis (LD) of HIV infection, their risk factors and the missed opportunities for an earlier diagnosis. METHODS: One hundred and sixty-five patients diagnosed with HIV infection in Navarre between 2009 and 2113 were included. Logistic regression was used to study the factors associated with LD (CD4 < 350 cells/mm3 or AIDS defining disease at diagnosis). The presence of risk factors and clinical indicators of possible HIV infection in the 5 years preceding the diagnosis were analyzed. RESULTS: The global prevalence of LD was 55% (90/165). This percentage was greater in immigrant patients than in Spanish patients, and in those without previous serology tests. An interaction was observed between the age and origin of patients. In Spaniards the risk of LD rose with age after 40 years (OR: 3.72; 95%CI: 1.52-9.12) but this did not occur in immigrant patients. Of the 132 patients who had received medical care in the years prior to diagnosis, 20 (15%) had classical risk factors recorded in their history, 14 (11%) proceeded from regions with a high prevalence of HIV, and 46 (35%) had presented clinical indicators (only 24 of them 1 year before diagnosis) without a serology test being realized. CONCLUSIONS: In spite of multiple contacts with our health system, over half of the new cases of HIV infection are diagnosed late. Greater attention to clinical signs is needed and, above all, a better evaluation of the risk in asymptomatic patients.
