Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance
Enferm Infecc Microbiol Clin (Engl Ed). 2019 Feb;37(2):100-108.
doi: 10.1016/j.eimc.2018.03.007.
Epub 2018 May 1.
[Article in
English,
Spanish]
Authors
César Gargallo-Bernad
1
, Francisco Javier Sangrós-González
2
, Piedad Arazo-Garcés
3
, Rosa Martínez-Álvarez
3
, Carmen Malo-Aznar
4
, Alicia Gargallo-Bernad
5
, Alba Ballester-Luna
6
, Luis Eduardo Cabrero-Pascual
7
, Pablo Gil-Orna
8
, Víctor José Abadía-Gallego
8
, Isabel Torres-Peña
9
, Héctor Ordiz-Suárez
10
Affiliations
- 1 Servicio de Urgencias, Hospital de Barbastro, Huesca, España. Electronic address: c.gargallo.bernad@gmail.com.
- 2 Centro de Atención Primaria Torrero-La Paz, Sector II Zaragoza, Zaragoza, España.
- 3 Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España.
- 4 Dirección General de Salud Pública, Zaragoza, España.
- 5 Centro de Atención Primaria Casablanca, Sector II Zaragoza, Zaragoza, España.
- 6 Servicio de Medicina Interna, Hospital Ernest Lluch Martín, Calatayud, Zaragoza, España.
- 7 Servicio de Medicina Interna, Hospital Arnau de Vilanova, Lérida, España.
- 8 Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España.
- 9 Servicio de Urgencias, Hospital de Barbastro, Huesca, España.
- 10 Servicio de Urgencias, Fundación Hospital de Calahorra, Logroño, España.
Abstract
Introduction:
Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/μl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place.
Methods:
Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting.
Results:
435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss.
Conclusion:
In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.
Keywords:
Condiciones indicadoras; Diagnóstico tardío; Human immunodeficiency virus; Indicator conditions; Late diagnosis; Virus de la inmunodeficiencia humana.
Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
MeSH terms
-
Adolescent
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Adult
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Child
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Child, Preschool
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Delayed Diagnosis*
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Dermatitis, Seborrheic / epidemiology
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Early Diagnosis
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Emigrants and Immigrants / statistics & numerical data
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Erythema / epidemiology
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Female
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Fever of Unknown Origin / epidemiology
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HIV Infections / congenital
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HIV Infections / diagnosis*
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HIV Infections / epidemiology
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HIV Infections / transmission
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Humans
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Incidence
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Infant
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Infant, Newborn
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Male
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Middle Aged
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Patient Acceptance of Health Care
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Pneumonia / epidemiology
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Prevalence
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Primary Health Care
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Retrospective Studies
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Spain / epidemiology
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Symptom Assessment*
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Weight Loss
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Young Adult