Delayed HIV diagnosis common in Sweden, 2003–2010
Scandinavian Journal of Infectious Diseases Dec 2014
Katarina Widgren, Helena Skar, Torsten Berglund, Anna-Maria Kling, Anders Tegnell, and Jan Albert
From the 1Department for Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden*
2Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
3Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
4Theoretical Biology and Biophysics, T-6, Los Alamos National Laboratory, NM, USA
5Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
6Department of Science and Technology, Linköping University, Linköping, Sweden
*Previously the Department for Analysis and Prevention, Swedish Institute for Communicable Disease Control, Solna, Sweden.
Correspondence: Katarina Widgren, Folkhälsomyndigheten, 171 82 Solna, Sweden. E-mail: Widgren.firstname.lastname@example.org
Early diagnosis of HIV is important for the prognosis of individual patients, because antiretroviral treatment can be started at the appropriate time, and for public health, because transmission can be prevented.
Data were collected from 767 HIV patients who were diagnosed in Sweden during 2003–2010 and were infected in Sweden or born in Sweden and infected abroad. A recent infection testing algorithm (RITA) was applied to BED-EIA test results (OD-n < 0.8), CD4 counts (≥ 200 cells/μl), and clinical information. A recent infection classification was used as indicator for early diagnosis. Time trends in early diagnosis were investigated to detect population changes in HIV testing behavior. Patients with early diagnosis were compared to patients with delayed diagnosis with respect to age, gender, transmission route, and country of infection (Sweden or abroad).
Early diagnosis was observed in 271 patients (35%). There was no statistically significant time trend in the yearly percentage of patients with early diagnosis in the entire study group (p = 0.836) or in subgroups. Early diagnosis was significantly more common in men who have sex men (MSM) (45%) than in heterosexuals (21%) and injecting drug users (27%) (p < 0.001 and p = 0.001, respectively) in both univariate and multivariable analyses. The only other factor that remained associated with early diagnosis in multivariable analysis was young age group.
Approximately one-third of the study patients were diagnosed early with no significant change over time. Delayed HIV diagnosis is a considerable problem in Sweden, which does not appear to diminish.