Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database

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Assessing the predictive value of HIV indicator conditions in general practice : a case-control study using the THIN database. / Damery, Sarah; Nichols, Linda; Holder, Roger; Ryan, Ronan; Wilson, Sue; Warmington, Sally; Stokes-Lampard, Helen; Manavi, Kaveh.

In: British Journal of General Practice , Vol. 63, No. 611, 06.2013, p. e370-7.

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@article{b382ef5e571c4170bc3cc60c444451f8,
title = "Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database",
abstract = "BACKGROUND: UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.AIM: To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.DESIGN AND SETTING: A case-control study in primary care.METHOD: Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition.RESULTS: Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations).CONCLUSION: This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.",
keywords = "Adult, Biological Markers, Candidiasis, Oral, Case-Control Studies, Databases, Factual, Diarrhea, Female, Fever, General Practice, HIV Infections, Humans, Male, Mass Screening, Pneumonia, Bacterial, Practice Guidelines as Topic, Predictive Value of Tests, Primary Health Care, Socioeconomic Factors, Weight Loss",
author = "Sarah Damery and Linda Nichols and Roger Holder and Ronan Ryan and Sue Wilson and Sally Warmington and Helen Stokes-Lampard and Kaveh Manavi",
year = "2013",
month = jun,
doi = "10.3399/bjgp13X668159",
language = "English",
volume = "63",
pages = "e370--7",
journal = "British Journal of General Practice ",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",
number = "611",

}

RIS

TY - JOUR

T1 - Assessing the predictive value of HIV indicator conditions in general practice

T2 - a case-control study using the THIN database

AU - Damery, Sarah

AU - Nichols, Linda

AU - Holder, Roger

AU - Ryan, Ronan

AU - Wilson, Sue

AU - Warmington, Sally

AU - Stokes-Lampard, Helen

AU - Manavi, Kaveh

PY - 2013/6

Y1 - 2013/6

N2 - BACKGROUND: UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.AIM: To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.DESIGN AND SETTING: A case-control study in primary care.METHOD: Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition.RESULTS: Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations).CONCLUSION: This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.

AB - BACKGROUND: UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.AIM: To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.DESIGN AND SETTING: A case-control study in primary care.METHOD: Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition.RESULTS: Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations).CONCLUSION: This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.

KW - Adult

KW - Biological Markers

KW - Candidiasis, Oral

KW - Case-Control Studies

KW - Databases, Factual

KW - Diarrhea

KW - Female

KW - Fever

KW - General Practice

KW - HIV Infections

KW - Humans

KW - Male

KW - Mass Screening

KW - Pneumonia, Bacterial

KW - Practice Guidelines as Topic

KW - Predictive Value of Tests

KW - Primary Health Care

KW - Socioeconomic Factors

KW - Weight Loss

U2 - 10.3399/bjgp13X668159

DO - 10.3399/bjgp13X668159

M3 - Article

C2 - 23735407

VL - 63

SP - e370-7

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 0960-1643

IS - 611

ER -