No Time to Wait: How Many HIV Positive Gay Men Die Due to a Late Diagnosis?

In England and Wales, 5% of men who have sex with men are dying within a year of receiving their (late) AIDS diagnosis. In a recent annual report, the Chief Medical Officer (CMO) for England highlights the need to diagnose HIV infection early in the course of infection. A late diagnosis of HIV late in the course of infection results in late initiation of HAART, which has been shown to decrease morbidity and mortality, increases costs and reduces the probability of avoiding further transmission.

The CMO's report recommends annual HIV testing to all men who have had sex with men (MSM) and more targeted health promotion campaigns to promote the advantages of HIV antibody testing.

The objectives of the British researchers were to compute the estimated number and proportion of late AIDS diagnoses and the mortality rate among men who have sex with men in the UK. They also sought to define risk factors for a late diagnosis and for short-term mortality.

To achieve this, the investigators analyzed national HIV/AIDS case reports of new diagnoses linked to CD4 cell counts from the CD4 Surveillance Survey. Outcomes were late diagnosis (defined as CD4 cell count <200 x 106 cells/l at diagnosis) and short-term mortality (defined as death within 1 year of diagnosis).

Results

· Of 14,158 new diagnoses, 31% were estimated as late diagnoses.

· Despite a decreasing trend, an estimated 430 (25%) MSM were still diagnosed late in 2001.

· Late diagnosis disproportionately affected individuals diagnosed outside London, of non-white ethnicity and of older age.

· There were 710 (5.0% of 14,158) deaths within a year of HIV diagnosis.

· Estimated short-term mortality was 14% for MSM diagnosed late and 1% for others.

· Short-term mortality declined concurrently with availability of HAART and was independently associated with age and diagnosis outside London but not ethnicity.

In their conclusion, the authors write, “The continued late diagnosis of one in four MSM means these individuals lose the option to start therapy early, miss opportunities to prevent further transmission and are approximately 10 times more likely to die within a year of diagnosis.”

“Early diagnosis of all MSM in 2001 could have reduced short-term mortality by 84% and all mortality in that year by 22%.”

From the HIV/STI Department, Communicable Disease Surveillance Centre, Health Protection Agency's, Centre for Infections, London and the Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.

03/30/05

Reference
T R Chadborn and others. No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993-2002). AIDS 19(5): 513-520. March 25, 2005.