HIV/AIDS among Palestinians: Detection, clinical presentation, prognosis and HIV testing patterns, 1994-2010

Objectives: To describe the detection, clinical presentation, and prognosis of West Bank and East Jerusalem Palestinians infected with HIV/AIDS, and HIV testing patterns of Palestinians in the Jerusalem area. Design and methods: This was a case-control analysis comparing all 33 Palestinian HIV/AIDS patients who were referred to the Hadassah AIDS Center (HAC) over 17 years (1994-2010) with 77 non-Palestinian patients seen over the same period. The systematic sampling method was used to select the control group. Patterns of HIV testing were observed for the years 2002 and 2007. Results: Many Palestinian patients (36%) were diagnosed during their initial hospitalization, while 47.1% of non-Palestinians were diagnosed as outpatients. Significantly more opportunistic infections were detected during diagnosis among Palestinians (48.5%) than among non-Palestinians (9.1%, p<0.001). Overall mortality among Palestinian patients was 36.4% (12/33) vs. 6.5% (5/77) among non-Palestinians (p<0.001). No significant differences in the initial CD4 counts and viral load levels were noted between Palestinians and non-Palestinians (256/mm³ and log 4.58 copies/ml vs. 271/mm³ and log 4.49 copies/ml, respectively). Follow-up visits were more infrequent among Palestinians than among non-Palestinians: 9.8 (± 1.0) compared with 23.4 (± 12.9), respectively (p<0.001), over a median follow-up of 2.7 years for Palestinians and 8.1 years for non-Palestinians (p<0.001). With regard to HIV testing, 7.3% (72/989) of individuals tested in 2002 and 10.9% (202/1851) in 2007 were Palestinians. The most frequent reason for being tested among Palestinians was 'medical' (e.g., before in vitro fertilization, 69.4% in 2007); among non-Palestinians it was 'intimate relationships' (31% in 2007). Conclusion: These results show that despite an overall small number of Palestinian HIV/AIDS patients, late diagnosis and high mortality are very much in evidence.