• Vol. 41 No. 5, 194–199
  • 15 May 2012

Determinants of Late-Stage HIV Disease at Diagnosis in Singapore, 1996 to 2009



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Introduction: The delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies.

Materials and Methods: We included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009. Late-stage HIV infection is defined as CD4 count less than 200 mm3 or AIDS-defining opportunistic infections at first diagnosis or within one year of HIV diagnosis. We determined independent epidemiological risk factors for late-stage HIV infection at first diagnosis using multivariate logistic regression.

Results: Multivariate analysis showed that older age corresponded significantly with increasing odds of late-stage HIV infection. Compared to persons diagnosed at 15 to 24 years of age, those diagnosed at age 55 years and above were associated with 5-fold increased likelihood of late-stage infection (adjusted odds ratio (AOR): 5.17; 95% CI, 3.21 to 8.33). Chinese ethnicity, singlehood, and non-professional occupations were also significantly associated with late-stage HIV infection. Persons detected in the course of medical care had over 3.5 times the odds of late-stage infection (AOR: 3.55; 95% CI, 2.71 to 4.65). Heterosexual mode of transmission and having sex workers and social escorts as sexual partners, were the other epidemiological risk factors with significant associations.

Conclusion: The findings of this study emphasises the need to increase HIV awareness and to encourage early and regular HIV testing among at-risk persons.

The first case of HIV infection in Singapore was diagnosed in 1985, and the first case of AIDS was diagnosed in September 1986. Since then, the incidence of HIV infection has been on a rising trend (Fig. 1), and the proportion of late-stage HIV infection amongst newly diagnosed cases has also been noted to increase concomitantly (Fig. 2). The predominant mode of HIV transmission in Singapore since 1985 has been via the sexual route. Homosexual and bisexual modes of transmission were prevalent in the earlier period between 1985 and 1990. From 1991 onwards, heterosexual transmission became the dominant mode of HIV transmission in Singapore. As of end 2009, a total of 4404 cases of HIV/AIDS had been diagnosed, out of which 3956 (89.8%) were males, and 448 (10.2%) were females. This translates to a HIV notification rate of 12 per 100,000 persons in 2009.

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