Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne.
Clin Med (Lond). 2012 Oct;12(5):430-4. doi: 10.7861/clinmedicine.12-5-430.
The late diagnosis of HIV in patients across the UK is an increasing problem. Here, we report on a retrospective case-notes audit carried out to assess the impact of the 2008 UK HIV testing guidelines on clinical practice and identify missed opportunities for HIV testing. The audit was carried out in 2010 and focussed on patients with newly diagnosed HIV at centres providing adult HIV services across the UK. Data were collected on 1,112 patients, of whom 52.2% were found to have a late HIV diagnosis as defined as a CD4 T lymphocyte count of <350 cells/mm3. Most patients (62.6%) were diagnosed in traditional settings, with a significant increase in those diagnosed with HIV in non-traditional settings (33%) compared with the 2003 audit (18.5%) (p<0.001). The most frequent indicator conditions that patients had experienced were chronic diarrhoea or weight loss, sexually transmitted infection, blood dyscrasia or lymphadenopathy. A quarter of patients were identified as having had a missed opportunity for earlier diagnosis. Based on our results, we suggest that HIV testing needs to continue to expand across clinical settings to reduce the number of patients living with undiagnosed HIV infection.
在英国，患者艾滋病毒诊断延迟的情况日益严重。在这里，我们报告了一项回顾性病历审核，旨在评估 2008 年英国艾滋病毒检测指南对临床实践的影响，并确定艾滋病毒检测的错失机会。该审核于 2010 年进行，重点关注在英国各地提供成人艾滋病毒服务的中心新诊断出艾滋病毒的患者。共收集了 1112 名患者的数据，其中 52.2%被定义为 CD4 淋巴细胞计数<350 个/立方毫米的晚期艾滋病毒诊断。大多数患者（62.6%）在传统环境中被诊断出，与 2003 年的审核（18.5%）相比，在非传统环境中被诊断出艾滋病毒的患者显著增加（33%）（p<0.001）。患者经历的最常见指示病症是慢性腹泻或体重减轻、性传播感染、血液异常或淋巴结病。四分之一的患者被确定为有早期诊断的错失机会。根据我们的结果，我们建议需要继续扩大艾滋病毒检测的临床范围，以减少患有未确诊艾滋病毒感染的患者数量。
