The Impact of Delay in HIV Diagnosis on Patient Survival: Analysis of HIV Infection Trends from 2007 to 2023

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Date 2025 Feb 5

PMID 39910497

Authors

Riyaz A Shaik

Sharan K Holyachi

Mohammad S Ahmad

Mohammed Miraj

Syed Yousaf Kazmi

Mohammad Rehan Asad

Ali Faraz

Mirwais Ramozi

Ritu Kumar Ahmad

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: HIV disease is one of the major public health challenges and its early diagnosis and timely management play a vital role in reducing mortality. This study examines factors affecting the mortality of HIV patients and the effect of delay in diagnosis on survival.

Methods: In this retrospective cohort study, data from the ART Center of Koppal District Hospital, India, from April 2007 to August 2023 were used. Of the 11,799 patients, 8,092 with complete data were included in the final analysis. Demographic and clinical variables including age, gender, HIV status, treatment, laboratory parameters, TB infection and survival were investigated. Delayed diagnosis was defined as CD4 ≤ 350. Statistical analyzes were performed with Cox regression and survival curves (Kaplan-Meier).

Results: Out of 8092 patients, 5897 (72.8%) had delayed diagnosis. The average survival time for patients with delay was 61.55 months and without delay was 84.09 months. Delay in diagnosis increases the risk of death with HR 3.01 (95% CI: 2.67-3.40) in univariate analysis and HR 1.70 (95% CI: 1.48-1.96) in multivariate analysis. TS/TG patients had a higher risk of death than women with a HR of 1.64 (95% CI: 1.52-1.78) and patients over 45 with a HR of 2.17 (95% CI: 1.94-2.43) compared to those under 30. AIDS stage patients had a higher risk of death with HR 2.54 (95% CI: 2.34-2.75) and TB patients with HR 1.43 (95% CI: 1.31-1.56).

Conclusion: delay in diagnosis, age, disease stage and the presence of TB are important factors of mortality in patients with HIV. Early diagnosis and timely management of the disease can reduce the risk of death and increase the life expectancy of patients. Programs to increase awareness and access to diagnostic and treatment services should be strengthened.

References

Arantes L, Pedroso A, Menegueti M, Gir E, Botelho E, Silva A . Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target. Viruses. 2023; 15(10). PMC: 10612088. DOI: 10.3390/v15102097. View

Nakagawa F, May M, Phillips A . Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2012; 26(1):17-25. DOI: 10.1097/QCO.0b013e32835ba6b1. View

Jin Y, Cai C, Chen F, Qin Q, Tang H . [Survival analysis since diagnosis of HIV-positive injecting drug users aged 15 years and above in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2022; 43(6):860-864. DOI: 10.3760/cma.j.cn112338-20211214-00981. View

Pinkston M, Schierberl Scherr A . "Being diagnosed with HIV was the icing on the cake of my life": A case study of fostering resiliency through flexible interventions along the stigma-sickness slope. Psychotherapy (Chic). 2019; 57(1):50-57. DOI: 10.1037/pst0000255. View

Kostaki E, Limnaios S, Adamis G, Xylomenos G, Chini M, Mangafas N . Estimation of the determinants for HIV late presentation using the traditional definition and molecular clock-inferred dates: Evidence that older age, heterosexual risk group and more recent diagnosis are prognostic factors. HIV Med. 2022; 23(11):1143-1152. PMC: 10092532. DOI: 10.1111/hiv.13415. View

Fisher M . Late diagnosis of HIV infection: major consequences and missed opportunities. Curr Opin Infect Dis. 2008; 21(1):1-3. DOI: 10.1097/QCO.0b013e3282f2d8fb. View

Patel E, Solomon S, McFall A, Prata Menezes N, Tomori C, Srikrishnan A . Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. AIDS. 2022; 36(11):1583-1589. PMC: 9391282. DOI: 10.1097/QAD.0000000000003297. View

Sobrino-Vegas P, Garcia-San Miguel L, Caro-Murillo A, Miro J, Viciana P, Tural C . Delayed diagnosis of HIV infection in a multicenter cohort: prevalence, risk factors, response to HAART and impact on mortality. Curr HIV Res. 2009; 7(2):224-30. DOI: 10.2174/157016209787581535. View

Miedzinski L . Early Clinical Signs and Symptoms of HIV Infection: Delaying progression to AIDS. Can Fam Physician. 2011; 38:1401-10. PMC: 2146153. View

10.

Buchbinder S, Liu A . CROI 2019: advances in HIV prevention and plans to end the epidemic. Top Antivir Med. 2019; 27(1):8-25. PMC: 6550360. View

11.

Op de Coul E, van Sighem A, Brinkman K, van Benthem B, van der Ende M, Geerlings S . Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996-2014: results from a national observational cohort. BMJ Open. 2016; 6(1):e009688. PMC: 4716151. DOI: 10.1136/bmjopen-2015-009688. View

12.

. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016; 3(8):e361-e387. PMC: 5056319. DOI: 10.1016/S2352-3018(16)30087-X. View

13.

Ford N, Getahun H . Service integration to reduce HIV-associated TB mortality. Public Health Action. 2016; 5(4):204. PMC: 4682608. DOI: 10.5588/pha.15.0073. View

14.

Zarei N, Joulaei H, Darabi E, Fararouei M . Stigmatized Attitude of Healthcare Providers: A Barrier for Delivering Health Services to HIV Positive Patients. Int J Community Based Nurs Midwifery. 2015; 3(4):292-300. PMC: 4591575. View

15.

Swaminathan S, Ramachandran R, Baskaran G, Paramasivan C, Ramanathan U, Venkatesan P . Risk of development of tuberculosis in HIV-infected patients. Int J Tuberc Lung Dis. 2000; 4(9):839-44. View

16.

Dilernia D, Monaco D, Cesar C, Krolewiecki A, Friedman S, Cahn P . Estimation of HIV-testing rates to maximize early diagnosis-derived benefits at the individual and population level. PLoS One. 2013; 8(1):e53193. PMC: 3538781. DOI: 10.1371/journal.pone.0053193. View

17.

Fauk N, Ward P, Hawke K, Mwanri L . HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia. Front Med (Lausanne). 2021; 8:625787. PMC: 8149745. DOI: 10.3389/fmed.2021.625787. View

18.

Poon P, Wong N, Leung W, Wong B, Kwong T, Kwan T . The differential impacts of early detection and accelerated antiretroviral therapy on the epidemiologic trend of sexually acquired HIV infection in Hong Kong. PLoS One. 2022; 17(9):e0274498. PMC: 9473389. DOI: 10.1371/journal.pone.0274498. View

19.

Alvarez-Uria G . Factors associated with delayed entry into HIV medical care after HIV diagnosis in a resource-limited setting: Data from a cohort study in India. PeerJ. 2013; 1:e90. PMC: 3691786. DOI: 10.7717/peerj.90. View

20.

Ickovics J, FORSYTH B, Ethier K, Harris P, Rodin J . Delayed entry into health care for women with HIV disease. AIDS Patient Care STDS. 1996; 10(1):21-4. DOI: 10.1089/apc.1996.10.21. View