Late presentation to HIV testing is overestimated when based on the consensus definition

A Sasse; E Florence; A Pharris; S De Wit; P Lacor; D Van Beckhoven; J Deblonde; M-L Delforge; Katrien Fransen; J-C Goffard; J-C Legrand; M Moutschen; D Piérard; J Ruelle; D Vaira; B Vandercam; M Van Ranst; E Van Wijngaerden; L Vandekerckhove; C Verhofstede; Belgian Research AIDS & HIV Consortium (BREACH)

doi:10.1111/hiv.12292

Late presentation to HIV testing is overestimated when based on the consensus definition

A Sasse, E Florence, A Pharris, S De Wit, P Lacor, D Van Beckhoven, J Deblonde, M-L Delforge, Katrien Fransen, J-C Goffard, J-C Legrand, M Moutschen, D Piérard, J Ruelle, D Vaira, B Vandercam, M Van Ranst, E Van Wijngaerden, L Vandekerckhove, C VerhofstedeBelgian Research AIDS & HIV Consortium (BREACH)

Research output: Contribution to journal › A1: Web of Science-article › peer-review

18 Downloads (Pure)

Abstract

OBJECTIVES: In 2011, a consensus was reached defining "late presenters" (LPs) as individuals presenting for care with a CD4 count < 350 cells/μL or with an AIDS-defining event, regardless of CD4 count. However, a transient low CD4 count is not uncommon in recent infections. The objective of this study was to investigate how measurements of late presentation change if the clinical stage at the time of diagnosis is taken into account.

METHODS: Case surveillance data for newly diagnosed patients in Belgium in 1998-2012 were analysed, including CD4 count at diagnosis, the presence of AIDS-defining events, and recent infections (< 6 months) as reported by clinicians in the case of acute illness or a recent negative test. First, proportions of LPs were calculated according to the consensus definition. Secondly, LPs were reclassified as "nonlate" if infections were reported as recent.

RESULTS: A total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P < 0.001). The proportion of patients misclassified as LPs increased significantly over time: 5% in MSM in 1998 vs. 41% in 2012.

CONCLUSIONS: This study suggests that low CD4 counts in recent infections may lead to overestimation of late presentation when applying the consensus definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered.

Original language	English
Journal	HIV Medicine
Volume	17
Issue number	3
Pages (from-to)	231-234
Number of pages	4
ISSN	1464-2662
DOIs	https://doi.org/10.1111/hiv.12292
Publication status	Published - 2016

Access to Document

10.1111/hiv.12292Licence: CC BY

2016hmed0231Final published version, 784 KBLicence: CC BY

Cite this

Sasse, A., Florence, E., Pharris, A., De Wit, S., Lacor, P., Van Beckhoven, D., Deblonde, J., Delforge, M.-L., Fransen, K., Goffard, J.-C., Legrand, J.-C., Moutschen, M., Piérard, D., Ruelle, J., Vaira, D., Vandercam, B., Van Ranst, M., Van Wijngaerden, E., Vandekerckhove, L., ... Belgian Research AIDS & HIV Consortium (BREACH) (2016). Late presentation to HIV testing is overestimated when based on the consensus definition. HIV Medicine, 17(3), 231-234. https://doi.org/10.1111/hiv.12292

@article{77fcb48af321443394cb9009ed5b33b3,

title = "Late presentation to HIV testing is overestimated when based on the consensus definition",

abstract = "OBJECTIVES: In 2011, a consensus was reached defining {"}late presenters{"} (LPs) as individuals presenting for care with a CD4 count < 350 cells/μL or with an AIDS-defining event, regardless of CD4 count. However, a transient low CD4 count is not uncommon in recent infections. The objective of this study was to investigate how measurements of late presentation change if the clinical stage at the time of diagnosis is taken into account.METHODS: Case surveillance data for newly diagnosed patients in Belgium in 1998-2012 were analysed, including CD4 count at diagnosis, the presence of AIDS-defining events, and recent infections (< 6 months) as reported by clinicians in the case of acute illness or a recent negative test. First, proportions of LPs were calculated according to the consensus definition. Secondly, LPs were reclassified as {"}nonlate{"} if infections were reported as recent.RESULTS: A total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P < 0.001). The proportion of patients misclassified as LPs increased significantly over time: 5% in MSM in 1998 vs. 41% in 2012.CONCLUSIONS: This study suggests that low CD4 counts in recent infections may lead to overestimation of late presentation when applying the consensus definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered.",

author = "A Sasse and E Florence and A Pharris and {De Wit}, S and P Lacor and {Van Beckhoven}, D and J Deblonde and M-L Delforge and Katrien Fransen and J-C Goffard and J-C Legrand and M Moutschen and D Pi{\'e}rard and J Ruelle and D Vaira and B Vandercam and {Van Ranst}, M and {Van Wijngaerden}, E and L Vandekerckhove and C Verhofstede and {Belgian Research AIDS & HIV Consortium (BREACH)}",

note = "FTX",

year = "2016",

doi = "10.1111/hiv.12292",

language = "English",

volume = "17",

pages = "231--234",

journal = "HIV Medicine",

issn = "1464-2662",

publisher = "John Wiley & Sons",

number = "3",

}

Sasse, A, Florence, E, Pharris, A, De Wit, S, Lacor, P, Van Beckhoven, D, Deblonde, J, Delforge, M-L, Fransen, K, Goffard, J-C, Legrand, J-C, Moutschen, M, Piérard, D, Ruelle, J, Vaira, D, Vandercam, B, Van Ranst, M, Van Wijngaerden, E, Vandekerckhove, L, Verhofstede, C & Belgian Research AIDS & HIV Consortium (BREACH) 2016, 'Late presentation to HIV testing is overestimated when based on the consensus definition', HIV Medicine, vol. 17, no. 3, pp. 231-234. https://doi.org/10.1111/hiv.12292

TY - JOUR

T1 - Late presentation to HIV testing is overestimated when based on the consensus definition

AU - Sasse, A

AU - Florence, E

AU - Pharris, A

AU - De Wit, S

AU - Lacor, P

AU - Van Beckhoven, D

AU - Deblonde, J

AU - Delforge, M-L

AU - Fransen, Katrien

AU - Goffard, J-C

AU - Legrand, J-C

AU - Moutschen, M

AU - Piérard, D

AU - Ruelle, J

AU - Vaira, D

AU - Vandercam, B

AU - Van Ranst, M

AU - Van Wijngaerden, E

AU - Vandekerckhove, L

AU - Verhofstede, C

AU - Belgian Research AIDS & HIV Consortium (BREACH)

N1 - FTX

PY - 2016

Y1 - 2016

N2 - OBJECTIVES: In 2011, a consensus was reached defining "late presenters" (LPs) as individuals presenting for care with a CD4 count < 350 cells/μL or with an AIDS-defining event, regardless of CD4 count. However, a transient low CD4 count is not uncommon in recent infections. The objective of this study was to investigate how measurements of late presentation change if the clinical stage at the time of diagnosis is taken into account.METHODS: Case surveillance data for newly diagnosed patients in Belgium in 1998-2012 were analysed, including CD4 count at diagnosis, the presence of AIDS-defining events, and recent infections (< 6 months) as reported by clinicians in the case of acute illness or a recent negative test. First, proportions of LPs were calculated according to the consensus definition. Secondly, LPs were reclassified as "nonlate" if infections were reported as recent.RESULTS: A total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P < 0.001). The proportion of patients misclassified as LPs increased significantly over time: 5% in MSM in 1998 vs. 41% in 2012.CONCLUSIONS: This study suggests that low CD4 counts in recent infections may lead to overestimation of late presentation when applying the consensus definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered.

AB - OBJECTIVES: In 2011, a consensus was reached defining "late presenters" (LPs) as individuals presenting for care with a CD4 count < 350 cells/μL or with an AIDS-defining event, regardless of CD4 count. However, a transient low CD4 count is not uncommon in recent infections. The objective of this study was to investigate how measurements of late presentation change if the clinical stage at the time of diagnosis is taken into account.METHODS: Case surveillance data for newly diagnosed patients in Belgium in 1998-2012 were analysed, including CD4 count at diagnosis, the presence of AIDS-defining events, and recent infections (< 6 months) as reported by clinicians in the case of acute illness or a recent negative test. First, proportions of LPs were calculated according to the consensus definition. Secondly, LPs were reclassified as "nonlate" if infections were reported as recent.RESULTS: A total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P < 0.001). The proportion of patients misclassified as LPs increased significantly over time: 5% in MSM in 1998 vs. 41% in 2012.CONCLUSIONS: This study suggests that low CD4 counts in recent infections may lead to overestimation of late presentation when applying the consensus definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered.

U2 - 10.1111/hiv.12292

DO - 10.1111/hiv.12292

M3 - A1: Web of Science-article

C2 - 26222266

SN - 1464-2662

VL - 17

SP - 231

EP - 234

JO - HIV Medicine

JF - HIV Medicine

IS - 3

ER -

Late presentation to HIV testing is overestimated when based on the consensus definition

Abstract

Access to Document

Fingerprint

Cite this