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Evidence that late HIV testing is a major problem, particularly for certain groups of HIV-infected people, was bolstered by a recently published study based on the HIV Cost and Service Utilization Study. The new study, published in the American Journal of Public Health, found that older, nonwhite people often had been first diagnosed with HIV after they already were ill.1
"Prior studies have principally focused on looking at older HIV patients, principally among minorities, and these were small samples," says David S. Zingmond, MD, MA. Zingmond is Star Research Fellow and clinical instructor in the department of medicine in the division of general, internal medicine and health services research at the University of California - Los Angeles.
The UCLA study, by contrast, had a nationally representative probability sample of 2,864 HIV-infected adults receiving care in the United States. About 11% of the patients who completed the baseline survey were at least 50 years old, and half of those patients were nonwhite, including Hispanics.1 The older subjects reported more disability and more often lived alone than the younger subjects of the survey. While the younger HIV patients reported more drug dependency within the past year, the older HIV patients reported similar rates of heavy alcohol use. Older HIV patients, particularly those who were nonwhite, were more likely to have been ill before being diagnosed with HIV infection.
The study was unable to determine precisely why older nonwhite HIV patients were diagnosed later in their disease, but one possible answer might lie in the finding that older patients, particularly nonwhite ones, tend to report fewer symptoms to clinicians, Zingmond says. "The implication could be they report fewer symptoms because they’re healthier, or they report fewer symptoms because they disregard the symptoms," Zingmond says. "In HIV and non-HIV literature it is true that older individuals report fewer symptoms, but how to put that together is not clear."
What is clear from the survey is that older nonwhite HIV patients are being diagnosed at a later stage of disease despite having a regular source of health care, and this leads to more rapid disease progression, Zingmond says. This fact alone suggests that clinicians need to screen older nonwhite patients more carefully, asking specific questions about symptoms and risk factors that the patient may otherwise fail to disclose. "If you’re older and poorer and less educated and socioeconomically disadvantaged, then you’re more likely to have health care problems, and this is a general observation across diseases," Zingmond says.
1. Zingmond DS, Wenger NS, Crystal S, et al. Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans. Am J Pub Health 2001; 91:15-18.