People are testing for HIV and showing up for HIV care later in the disease process now than they were in 1990, according to a new study reported by AIDSmap.com. To remedy this problem, the study authors conclude that current universal HIV testing efforts should also require universal health care, if there is to be a significant impact on diagnosing HIV infection at the earliest stage possible.

In the study, published in Clinical Infectious Diseases, Jeanne Keruly, BSN, and Richard Moore, MD, of the Johns Hopkins University School of Medicine in Baltimore, examined the medical records of 3,348 patients who presented for care at any of the Johns Hopkins HIV clinics between 1990 and 2006.

While more recently diagnosed patients entered HIV care sooner than those diagnosed in earlier years, they were also more likely to enter care with more advanced HIV disease. Between 1990 and 1994, people averaged 271 days between the time of their diagnosis and their entry into care, compared with 196 days among those diagnosed between 2003 and 2006. However, among patients presenting for care between 1990 and 1994, the average CD4 count was 371 cells, compared with 276 cells among those presenting for care between 2003 and 2006. Patients who presented for care between 2003 and 2006 were more likely to be African American, to have been exposed to HIV through heterosexual sex and to be older than those who first presented between 1990 and 1994.

The researchers believe that the later diagnoses and entries into care through the Johns Hopkins HIV clinics may be due to a lack of access to HIV testing and health care in general. They also suspect this may be occurring in other parts of the country and conclude that “our health care system appears to be less capable of detecting the disease early in its course than it was nearly two decades ago.”