Objectives: To describe the proportion of HIV-infected heterosexual individuals diagnosed late and estimate how much mortality could have been prevented by earlier diagnosis.
Design: A population-based study using surveillance reports from England and Wales.
Methods: Calculation of proportions diagnosed late (CD4 cell count < 200 cells/μl) and short-term mortality (death within a year of diagnosis).
Results: A total of 16 375 heterosexual individuals were diagnosed with HIV (2000–2004): 10 503 with CD4 cell counts available at that time; 42% (4425) were diagnosed late. Late diagnosis increased with age (P < 0.01). One fifth of women diagnosed antenatally were diagnosed late compared with 42% of other women and 49% of men; 70% of all heterosexuals diagnosed were black Africans, born and infected in Africa. Of those, at least 40% were recent arrivals to the UK, and twice as many were diagnosed late as black-African heterosexuals infected in the UK. Short-term mortality was 3.2% (491/15 523); 6.1% among those diagnosed late and 0.7% among others (P < 0.01). Short-term mortality was lower among black-African compared with white heterosexuals (3.1 versus 4.5%; P < 0.01) because of diagnosis at a younger age. Earlier diagnosis would have reduced short-term mortality by 56% (249 fewer deaths) and all mortality by 32% between 2000 and 2004.
Conclusion: Groups at high risk of late diagnosis should be targeted for health promotion activities, opportunistic screening, and removal of any barriers to testing. HIV testing in a variety of settings would reduce missed diagnoses and costs. New patient checks in primary care may provide the earliest opportunity to diagnose HIV infection among recent arrivals to the UK.
From the aHIV and STI Department, Health Protection Agency Centre for Infections, London, UK
bDepartment of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
Received 18 May, 2006
Revised 19 July, 2006
Accepted 25 September, 2006
Correspondence to Tim Chadborn, HIV and STI Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. Tel: +44 0 20 8327 7559; fax: +44 0 20 8200 7868; e-mail: email@example.com