Delayed Diagnosis and Treatment for AIDS Results in Severe Complications

Although life-saving antiretroviral treatment is available, people infected with human immunodeficiency virus (HIV) continue to suffer from complications and even die from AIDS. This is mainly due to delayed diagnosis and initiation of treatment.

Scientists at Albert Einstein College of Medicine of Yeshiva University (Bronx, NY, USA) and colleagues at Yale University (New Haven, CT, USA) conducted a study that has shed light on why this problem persists. Led by Dr. Neel Gandhi, assistant professor of medicine and of epidemiology and population health at Einstein, the investigators examined 4,368 patients presenting for AIDS treatment to Veteran's Administration (VA) Medical Centers in the United States for the first time between 1998 and 2002. Their aim was to determine whether patients who had received medical care in the VA healthcare system were diagnosed with the HIV infection that causes AIDS earlier than patients outside the VA or those who were accessing the VA system for the first time.

Half of all the patients in the study had AIDS at the time of presentation--a seemingly high proportion but one that was similar to studies conducted outside the VA healthcare system. "What was particularly astounding to us was the fact that 40% of these patients with AIDS had previously received medical care at the VA for other illnesses, but had not been diagnosed with HIV infections and treated earlier,” explained Dr. Gandhi. "This occurred even though they had an average of six physician visits over three-and-a-half years. Even more concerning was that those patients who already interacted with the healthcare system for several years suffered the end-stage complications of AIDS at the same rate as those who were new to the VA healthcare system.”

A possible explanation for this is that patients with HIV infection remain asymptomatic until very late in the disease, providing few clues to doctors of the patient's underlying HIV infection. "In our study, we found that only 12% of patients with AIDS at the time of presentation for treatment had previously suffered from an illness indicative of unrecognized HIV infection,” noted Dr. Gandhi. "The vast majority of these patients with AIDS had no signs or symptoms of HIV infection until they suffered end-stage complications from AIDS. Most of these AIDS complications could have been prevented if these HIV-infected people had been routinely screened when they were first seen by a doctor and had begun antiretroviral treatment earlier.”

Dr. Gandhi added, "A previously published study has shown routine screening for HIV infection is a cost-effective addition to the screening done for other life-threatening diseases, such as heart disease and several types of cancer. Assuming that patients give their permission to be screened for HIV, the potential savings from diagnosing an infection earlier would be quite significant.”

The findings of the study support a recommendation by the U.S. Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) to screen all patients in all healthcare settings for HIV-infection.


Related Links:
Albert Einstein College of Medicine of Yeshiva University
Yale University
U.S. Centers for Disease Control and Prevention