Late Presentation to HIV Care

Dear Colleagues,

The World Health Organization defines “late presentation” as a new HIV diagnosis with concurrent acquired immunodeficiency syndrome (AIDS)-defining events, or a new HIV diagnosis with a CD4+ count less than 350 cells/mm³.

Late presentation is associated with ongoing HIV transmission, lower antiretroviral treatment outcomes, lower chances of experiencing a robust CD4+ cell gain, higher HIV reservoirs, higher healthcare costs, and overall more adverse outcomes and co-morbidities, eventually including a shorter life expectancy. Late HIV diagnosis remains a major challenge for most European countries. The percentage is approximately 40% and varied across transmission categories. It increases with age, ranging from 33% among people aged 15–19 at diagnosis to 65% among those aged 50 years or above. On the other hand, an early initiation of antiretroviral treatment has been associated with a substantially smaller HIV reservoir, thus reinforcing the need for proactive strategies to diagnose occult HIV infection.

There is an ongoing need for an opportunistic automated HIV screening strategy to reduce late diagnosis rates and detect missed opportunities for earlier diagnosis. Moreover, screening and testing awareness campaigns have had a limited impact in lowering late diagnosis numbers, and insufficient HIV testing in different healthcare settings seems to be generalized. Not unexpectedly, healthcare professionals and the health system itself have been identified as two of the major barriers to proactive HIV testing, allegedly because of a lack of time, a lack of training, uneasiness discussing sexual health with patients, or even fear of being perceived as discriminatory by patients.

In this Special Issue of Microorganisms, we review the current situation of late HIV presentation in Europe, the determinants associated with it, its impact on life expectancy and causes of death, the established HIV reservoir and comorbidities, as well as strategies targeted at proactively diagnosing subjects with occult HIV infection in healthcare facilities.

Dr. Raquel Martín-Iguacel
Dr. Josep Maria Llibre
Guest Editors

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• late HIV presentation
• late HIV treatment initiation
• occult HIV
• late presenter
• HIV screening
• HIV screening strategies
• early antiretroviral treatment