Epidemiological assessment of factors associated with late diagnosis of HIV infection

Background. Late diagnosis of human immunodeficiency virus (HIV) infection contributes to its spread and becomes an obstacle to achieving the goal of early treatment.

Aim. To conduct an epidemiological analysis of factors associated with late diagnosis of HIV infection.

Material and methods. The study included data from 348 patients over 18 years of age living in Kazan, who were diagnosed with HIV infection for the first time in 2019. The proportion of patients with late diagnosis of HIV infection was determined. The criteria for late diagnosis were the level of CD4+-lymphocytes less than 200 cells/mm3 and/or the presence of 4 HIV stage (stage of secondary diseases) at the time of diagnosis. The assessment of the influence of probable factors on the timeliness of diagnosis was carried out using binary logistic regression. The regression model included data from 307 people who managed to determine the timeliness of diagnosis. For each factor, odds ratios were calculated (unadjusted — based on the results of univariate analysis, adjusted — based on the results of multivariate analysis), as well as their 95% confidence intervals.

Results. Late diagnosis of HIV infection was noted in 32.6% of cases. Examination for clinical indications was associated with late diagnosis in comparison with examination for preventive purposes (adjusted odds ratio 2.427, 95% confidence interval 1.184–4.973). The age of 50 years and older was associated with late diagnosis compared with patients 30–49 years of age (adjusted odds ratio 3.348, 95% confidence interval 1.542–7.265).The chances of late diagnosis under the age of 30 years are 5 times lower than in the 30–49 year old group (adjusted odds ratio 0.200, 95% confidence interval 0.072–0.556). The odds of late diagnosis are significantly higher among people who become infected through parenteral transmission through injecting drug use compared to those who become infected through sexual (heterosexual) transmission (adjusted odds ratio 2.012, 95% confidence interval 1.042–3.885).

Conclusion. In order to control the spread of HIV infection in the population, it is necessary to increase the coverage of HIV screening testing for all population groups, especially the older age group and injecting drug users.