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Delays and missed opportunities persist in diagnosing patients with unrecognized HIV infection

An estimated 900,000 people in the United States are infected with HIV, and about 40,000 new HIV infections occur annually. However, timely diagnosis of HIV remains a critical barrier to effective treatment. A new study, supported in part by the Agency for Healthcare Research and Quality (F32 HS11509), recently documented missed opportunities and delays in the diagnosis of patients with HIV infection.

Jason S. Haukoos, M.D., M.S., of the University of Colorado Health Sciences Center, and his colleagues examined medical records and other data on newly diagnosed HIV-infected patients. The patients, most of whom were minorities, were seen at an urban medical center during 1998 and 1999. Researchers analyzed data from all emergency department and clinic visits at the medical center for a 3-year period preceding the first diagnosis of HIV infection to determine delays and missed opportunities for HIV diagnosis.

Of the 76 newly diagnosed patients, 69 had made a diagnostic health care visit (DHV), and 23 had made a combined total of 53 health care visits preceding the diagnosis of their HIV infection. The median delay in diagnosis of HIV infection for patients who had a DHV was 2 days, although 19 patients had a delay in diagnosis of 30 days or more. The median delay in diagnosis for patients who had a previous visit was 112 days. Half (38) of the 76 patients had at least one risk factor for HIV documented during a medical visit.

Researchers also found that documenting of specific risk factors (such as risky sexual practices, injection drug use, or blood transfusion between 1977 and 1985) and clinical characteristics suggestive of HIV infection (such as unexplained weight loss, active tuberculosis, recurrent pneumonia, or hepatitis B or C infection) was poor. These findings underscore the need for clinicians to maintain a high awareness for the possibility of HIV infection in all patients.

See "Recognition of undiagnosed HIV infection: An evaluation of missed opportunities in a predominantly urban minority population," by Albert M. Kuo, M.D., Dr. Haukoos, Mallory D. Witt, M.D., and others in the April 2005 AIDS Patient Care and STDs 19(4), pp. 239-246.

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