Despite the availability of life-saving antiretroviral treatment, people infected with HIV (human immunodeficiency virus) continue to die and suffer from complications of AIDS, mainly due to delayed diagnosis and initiation of treatment. A researcher at the Albert Einstein College of Medicine of Yeshiva University and colleagues at Yale University have shed light on why this problem persists.
Led by Dr. Neel Gandhi, assistant professor of medicine and of epidemiology and population health at Einstein, the researchers examined 4,368 patients presenting for AIDS treatment to Veteran’s Administration (VA) Medical Centers nationwide for the first time between 1998 and 2002. Their aim was to determine whether patients who had received medical care in the VA healthcare system were diagnosed with the HIV infection that causes AIDS earlier than patients outside the VA or those who were accessing the VA system for the first time.
Half of all the patients in the study had AIDS at the time of presentation—a high rate that nevertheless was similar to studies conducted outside the VA healthcare system. “What was particularly astounding to us was the fact that 40 percent of these patients with AIDS had previously received medical care at the VA for other illnesses, but had not been diagnosed with HIV infections and treated earlier,” explains Dr. Gandhi. “This occurred even though they had an average of six physician visits over three-and-a-half years. Even more concerning was that those patients who already interacted with the healthcare system for several years suffered the end-stage complications of AIDS at the same rate as those who were new to the VA healthcare system.”
One explanation for why this may occur is that patients with HIV infection remain asymptomatic until very late in the disease, providing few clues to doctors of the patient’s underlying HIV infection. “In our study, we found that only 12% of patients with AIDS at the time of presentation for treatment had previously suffered from an illness indicative of unrecognized HIV infection,” notes Dr Gandhi. “The vast majority of these patients with AIDS had no signs or symptoms of HIV infection until they suffered end stage complications from AIDS. Most of these AIDS complications could have been prevented if these HIV-infected people had been routinely screened when they were first seen by a doctor and had begun antiretroviral treatment earlier.”
He adds, “A previously published study has shown routine screening for HIV infection is a cost-effective addition to the screening done for other life-threatening diseases, such as heart disease and several types of cancer. Assuming that patients give their permission to be screened for HIV, the potential savings from diagnosing an infection earlier would be quite significant.”
The findings of the study support a recommendation by the US Centers for Disease Control and Prevention (CDC) to screen all patients in all healthcare settings for HIV-infection.
Dr. Gandhi conducted much of this study as a member of the Robert Wood Johnson Clinical Scholars Program of Yale University, with colleagues from Veterans Aging Cohort Study of the West Haven Veteran’s Administration Hospital. The research received funding from the Robert Wood Johnson Clinical Scholars Program, The National Institute of Alcoholism and Alcohol, and the Veterans Affairs Office of Research and Development.
They report their findings in the November issue of the journal Medical Care.
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