How Well Are We Performing the Initial Assessment of HIV-Positive Patients?

Results From a Multicentre Cohort in Spain

I Suárez-García; B Alejos; E Delgado; M Rivero; JA Pineda; I Jarrin

Disclosures

HIV Medicine. 2020;21(2):128-134. 

In This Article

Abstract and Introduction

Abstract

Objectives: The aim of this study was to evaluate adherence to the recommendations of the Spanish guidelines for the initial assessment of patients with HIV infection in the multicentre Cohort of the Spanish HIV/AIDS Network (CoRIS) during the years 2004–2017.

Methods: We calculated the percentage of patients who had each of 11 clinical and analytical recommended examinations performed in their initial evaluation. We evaluated the factors associated with not performing each examination with multivariable logistic regression models.

Results: We included 13 612 patients in the study. In the initial assessment, CD4 count and viral load were determined in more than 98.0% of the patients. Serologies for hepatitis A, B and C and syphilis were determined in 55.8%, 66.4%, 89.8% and 81.7% of the patients, respectively. Total cholesterol and creatinine were determined in 78.7% and 78.9% of the patients, respectively. The lowest proportions of examinations were observed for blood pressure, smoking status and latent tuberculosis screening, which were performed in 43.2%, 50.6% and 53.9% of the patients, respectively. Injecting drug users and heterosexual patients (compared to men who have sex with men) and patients with a lower educational level had a higher risk of having an incomplete initial assessment for a substantial number of examinations. Latent tuberculosis screening was less likely in patients with CD4 counts < 200 cells/μL.

Conclusions: The initial assessment of HIV-infected patients is suboptimal for the evaluation of cardiovascular risk, smoking status, screening of syphilis and viral hepatitis, and diagnosis of latent tuberculosis: adherence to the guidelines was low for these examinations.

Introduction

Several guidelines provide recommendations on the assessment of HIV-positive persons at their initial visit in order to prevent and diagnose several comorbid conditions.[1–3] However, very little is known about whether these recommendations are followed in clinical practice. Information about the completeness of the initial evaluation of HIV-infected patients is very scarce in the literature: this issue has not been assessed specifically, and the evidence is limited to very few studies that assess the fulfilment of quality indicators for HIV care with a very limited number of patients and centres, in which the indicators include a few examinations in the baseline evaluation.[4,5]

Routine data from research cohorts can provide a way of evaluating the completeness of the initial assessment of HIV-infected patients and detecting shortcomings that should be addressed. The aim of this study was to evaluate adherence to the recommendations of the Spanish guidelines for the initial assessment of patients with HIV infection[2] in a multicentre cohort.

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