HIV infection – mind the diagnosis gap
The development of treatments for HIV infection has been one of the great achievements of modern medicine. In recent years, people receiving antiretroviral therapy for HIV infection are healthier and living longer, with a greater quality of life due to medical, technological and social advances.
However, while treatments are improving, the time between infection and diagnosis remains an issue.
This was highlighted by a recent US Center for Disease Control and Prevention (CDC) study.
The investigation found that in 2015, 50% of people with HIV were infected with the virus for 3 or more years before diagnosis. Furthermore, 40% of new infections came from people who were unaware of their infection. Heterosexual men at increased risk of infection, in particular, experienced a delayed diagnosis – with half of this group being diagnosed 5 or more years after infection.
The good news from this analysis was that the median time from infection to diagnosis decreased by 7 months since 2011. However, the delay between HIV acquisition and diagnosis remains a major target for improvement.
CDC recommends routine testing, with the frequency dependent on risk posed to the individual, and is campaigning to increase awareness of the necessity for regular testing in the US. However, it will be important to extend these strategies beyond the US healthcare system to include the 14 million people – estimated by UNAIDS – with HIV infection who do not know their HIV status globally. Furthermore, most new infections occur in regions with decreased access to information, for example, 66% of new infections occur in Sub-Saharan Africa. Channelling the message to these regions will pose more of a challenge.
To improve time to diagnosis, further education and awareness will be required for both the public and healthcare professionals. Any campaigning will need to be targeted based on the patient groups at greatest risk of missing a diagnosis and the healthcare systems that they have access to.
By addressing the diagnosis gap in tandem with further improving infection prevention and treatment, the goal of HIV disease eradication may be achievable.