1. BORDERNETwork Training on Late Presenter Dr. med. Wolfgang Güthoff / Alexander Leffers, M.A. www.bordernet.eu www.aidshilfe-potsdam.de

2. This presentation arises from the BORDERNETwork project which has received funding from the European Union, in the framework of the Health Program, and co- funding of the Ministry of Environment, Health and Consumer Protection of the Federal State of Brandenburg. The sole responsibility of any use that may be made of the information lies with the authors (SPI, AIDS-Hilfe Potsdam e.V.)

3. Definition of „Late Presenter“ Definition:  In the HIV initial diagnosis Quantity of CD4 cells < 200 cells/µl and/or Aids defining disease

4. Late Presenter – a global phenomenon Low median CD4 cells quantity at the begin of HAART:  Observation period 2003-2005  42 countries  176 centre’s  33.008 patients

5. Excursus: HIV in Germany Source: Robert Koch-Institut Year of the HIV diagnosis HIV in Germany (February 2009) Quantity of CD4 cells/µl in HIV initial diagnosis Age >= 15 years

6. Excursus: Newly diagnosed HIV cases in 2010 in EvB Klinikum Potsdam NoAge (Years)SexStageCD4-cells 123mA2284 239mA2377 323mA2312 424wA2370 517mA2295 663mC319 740mC396 878mC32 930mC318 1047wC328

7. The relevance of an early HIV diagnosis  A therapy of HIV can be initiated at the optimal moment  Opportunistic infections will be prevented  Improvement of the complete prognosis  With delayed begin of the therapy is the immune reconstitution rarely complete  Transmission risks will be reduced

8. Strategy for an early HIV diagnosis  Testing on HIV when a so called AIDS defining disease occurs  Testing on HIV when diseases and results occur, which are related in general to a HIV infection

9. HIV – Indicator diseases and -symptoms STRATEGY FOR AN EARLY DIAGNOSIS (I)  HIV testing, if diseases and results are often connected to an infection with HIV, the so called indicator diseases Sexually Transmitted Diseases Malign Lymphoma Cervical Dysplasia / Anal Dysplasia Herpes Zoster Symptoms similar to Mononucleosis Leukopenia Thrombopenia Seborrheic Dermatitis

10. AIDS defined diseases STRATEGY FOR AN EARLY DIAGNOSIS (II)  HIV – testing, if a so called AIDS defined diseases occurs: Bacterial pneumonia, recurrent (≥2 episodes in 12 months) Candidiasis, esophageal Cervical carcinoma Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (>1-month duration) Cytomegalovirus disease (other than liver, spleen, or nodes) Encephalopathy, HIV-related Herpes simplex: chronic ulcers (>1- month duration), or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis, chronic intestinal (>1- month duration) Kaposi sarcoma Lymphoma fever ≥1 month Mycobacterium avium complex (MAC), disseminated or extrapulmonary Mycobacterium tuberculosis Pneumocystis jiroveci (formerly carinii ) pneumonia (PCP) Progressive multifocal leukoencephalopathy (PML) Salmonella septicemia, recurrent (nontyphoid) Toxoplasmosis of brain Wasting syndrome due to HIV (involuntary weight loss >10% of baseline body weight) associated with either chronic diarrhea (≥2 loose stools per day ≥1 month) or chronic weakness and documented fever ≥1 month

11. LATE PRESENTERS SUMMARY  To avoid a late diagnosis: As physician: Think about HIV and offer your patient HIV testing, if: AIDS defined diseases occur indicator diseases occur or situations with a high risk of infection happened.