Growing number of people with HIV in west of Ireland already at advanced stage of illness when diagnosed, study finds

There are concerns over delays in diagnosing people with HIV in the west of Ireland, after a study found a growing number are at an advanced stage of the illness by the time they are aware of it.

The findings are being presented this weekend to the ESCMID Global Congress – which brings together experts in clinical microbiology and infectious diseases – in Barcelona, following a study by a team led by Galway infectious disease consultant Dr Ellen Walsh.

The study calls for the routine screening for HIV of all hospital admissions in the west and also improved access to healthcare for migrant populations.

It pointed out the infectious diseases service in University Hospital Galway provides HIV care for the west of Ireland, which is “a less densely populated area with different socioeconomic influences and patterns of migration compared to the east of the country”.

It said that while absolute numbers of HIV diagnoses are highest in the east, proportions presenting with advanced HIV infection at diagnosis are greatest outside this region.

Regional differences have not been explored in Ireland up to now and the study looked at cases over 10 years in University Hospital Galway, from January 2013 to November 2023.

The authors said 69 patients were included – 49 of whom had presented since 2018.

About 50 of the patients were men. Heterosexual transmission occurred in 53.6pc of cases, while 36.2pc were among men who have sex with men.

The authors found that 75pc of advanced diagnoses before 2018 were in Irish-born people, and this declined to 53.1pc in later years.

The findings show 5.5pc died and 55.1pc required hospitalisation, particularly those of an older age. Those admitted had a prolonged length of stay, with a median of 20.5 days, and 13pc were admitted to intensive care.

They found that 75.4pc had attended a healthcare setting before diagnosis, representing “a missed testing opportunity”.

The study showed a majority had symptoms common to HIV for between three and 26 months before diagnosis and a number also had Aids-defining conditions.

Commenting on the findings, Dr Walsh said: “Figures from the Health Protection Surveillance Centre show that higher proportions of people outside of the HSE east area are diagnosed with HIV infection at an advanced stage.

“Early diagnosis and initiation of treatment is key to reducing the complications of HIV infection.

“This research was carried out to identify the number of people receiving a HIV diagnosis at an advanced stage in the west of Ireland in order to improve testing strategies.

“We looked at opportunities for patients to request or be offered HIV testing before receiving their diagnosis.

“We found that those who were diagnosed with HIV at an advanced stage in primary care settings had better outcomes than those diagnosed in hospital.

“More frequent HIV testing should be offered to men who identify as heterosexual and to older age groups; almost 10pc of our study group were over 65 years old.

“This research supports the introduction of routine HIV testing in all healthcare settings.”

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