A review has shown that over the last five years, nearly 40% of people testing HIV-positive in San Francisco, United States, were diagnosed with AIDS less than a year after their diagnosis. This coincides with reports from across the US, in which ‘late testers’ made up 45% of the HIV-positive results.
Despite awareness campaigns aimed at getting ‘at-risk’ people to test as early as possible, many HIV-positive people are still unaware of their status. The longer an HIV-positive person is unaware that they are infected, the more people they may unwitting pass the virus along to, the lower their CD4 cell counts can fall, and the higher the risk of resulting opportunistic infections. A considerable number of people only discover that they are HIV-positive when they are hospitalised with a serious HIV-related illness.
An earlier study, published in the Morbidity and Mortality Weekly Report (MMWR) in 2003, looked at 5,980 people who tested positive for HIV at 16 sites across the United States between 2000 and 2003. Fully 45% of this number were classified as ‘late testers’: people who tested positive less than a year before being diagnosed with an ‘AIDS-defining’ condition (e.g. PCP pneumonia).
Another group of researchers has just analysed a group of 2,139 people who tested HIV-positive in San Francisco (a site not included in the MMWR 2003 study) between 2001 and 2005. They found that 830 (38.8%) met the same definition of ‘late tester’. The results, published in the December 1st issue of the Journal of Acquired Immune Deficiency Syndromes, showed that the late testers were more likely to:
- be under 30 years old
- be non-white
- have been born outside the US
- have acquired HIV through heterosexual contact, or to have no reported risk factor,
- have private health insurance or no health insurance.
People whose AIDS diagnosis was due to an opportunistic infection (rather than a CD4 cell count of less than 200 cells/mm3, which is also considered AIDS-defining in the US) were also more likely to be late testers. This would likely include the people who were tested for HIV specifically because they had developed an AIDS-related illness.
Other studies in San Francisco have found that nearly all (94%) men who have sex with men have been tested for HIV, and that fewer HIV-positive men are unaware of their status than in other US cities studied. While the researchers point out that their “findings might not generalize to other geographic area and populations”, studies in other countries have also found that immigrants, younger people, heterosexuals, and those without reported risk factors are more likely to be tested late.
The study concludes that testing of “persons who do not consider themselves to be at high risk for HIV infection should be pursued. Routine testing of most persons has been recommended as cost effective and efforts to promote such testing should be developed.”
References
Schwarcz S et al. Late diagnosis of HIV infection. J Acquir Immune Defic Syndr. 43(4): 491-494, 2006.
Centers for Disease Control. Late- versus early-testing of HIV – 16 sites, United States, 2000-2003. Morb Mortal Weekly Rep. 52: 581-586, 2003.