Background/introduction:

A significant proportion of patients (390/6360 (6.1%) in 2012 nationally) present with an AIDS defining illness yearly despite increasing awareness and recognition of HIV. In 2012 the British HIV Association (BHIVA) suggested newly diagnosed patients should commence Anti-Retroviral Therapy (ART) if their CD4 count <350 cells/mm3, they have an AIDS defining illness or a neurological complication.


Aim(s)/objectives:
A re-audit was performed following previous audits in 2006/07 and 2011/2012 to ascertain whether late presentation has improved.

Methods:

A retrospective study compiled data from case notes of the newly diagnosed between 01/01/2014 and 31/12/2015. Defining late presenters as a CD4 count <350 cells/mm3 or an AIDS defining illness.

Results:

100 patients were identified, 33 were transfers and excluded. 67 remained of which 82.1% were male and 17.9% female. 52.2% were late presenters and 25.4% had an AIDS defining illness of which 9 had PCP, 6 had oesophageal candidiasis, 1 had cryptococcal meningitis and 1 had OHL. Overall 35.8% had a CD4 <200 cells/mm3 (42.9% in 2011/2012 audit) and 68% of the late presenters. 


Discussion/conclusion:

An improvement was identified in patients presenting with a CD4 count <350 cells/mm3 (52.2%) compared with 2011/12 audit (55.7%). A high proportion continue to present with AIDS defining illnesses or depleted CD4 levels despite growing awareness of HIV and accessibility to health care. Poor prognosis, increasing morbidity and mortality is associated with late presentation. Atypical and opportunistic infections should prompt HIV testing amongst clinicians in both primary and secondary care along with improving patient education and contact tracing to minimize late presentation.

Late Presentation of HIV (Human Immunodeficiency Virus) Infection at a District General Hospital