Late diagnosis of HIV: An updated consensus definition
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Introduction: In recent years, HIV testing frequency has increased, resulting in more people being diagnosed during seroconversion with a temporarily low CD4 count. Using the current consensus definition of late HIV presentation ('presenting for care with a CD4 count < 350 cells/μL or an AIDS-defining event, regardless of CD4 count') these individuals would be incorrectly assigned as being diagnosed late. Methods: In spring 2022, a European expert group convened to revise the current late HIV presentation consensus definition. A survey on data availability to apply this revised definition was sent to nominated European focal points responsible for HIV surveillance (n = 53). Results: Experts agreed that the updated definition should refer to late HIV diagnosis rather than presentation and include the following addition: People with evidence of recent infection should be reclassified as 'not late', with evidence of recent infection considered hierarchically. The individual must have: (i) laboratory evidence of recent infection; (ii) a last negative HIV test within 12 months of diagnosis; or (iii) clinical evidence of acute infection. People with evidence of being previously diagnosed abroad should be excluded. A total of 18 countries responded to the survey; 83% reported capturing CD4 count and/or AIDS at diagnosis through national surveillance, 67% captured last negative test and/or previous HIV diagnosis, 61% captured seroconversion illness at diagnosis and 28% captured incident antibody results. Conclusions: Accurate data on late diagnosis are important to describe the effects of testing programmes. Reclassification of individuals with recent infection will help to better identify populations most at risk of poor HIV outcomes and areas for intervention.
|Status||Udgivet - 2022|
We would like to thank the ECDC and the WHO Regional Office for Europe for circulating the late HIV diagnosis survey to their European HIV Surveillance Network and the ECDC/WHO national HIV surveillance focal points for taking the time to complete it. We would also like to acknowledge the support of the EACS governing board and ART panel, the ECDC and the WHO Regional Office for Europe, as well as the members of the EuroTEST steering committee not already listed as authors: Ben Collins (European Testing Week working group chair, ReShape/International HIV Partnerships, UK), Brian Gazzard (Imperial College, School of Medicine, HIV Research Director, Chelsea and Westminster Hospital, UK), Cary James, (World Hepatitis Alliance, UK), Daniela Rojas Castro (Coalition PLUS, France), Ferenc Bagyinszky (AIDS Action Europe, Germany), Francesco Negro (European Association for the Study of the Liver, Switzerland), Igor Karpov (Department of Infectious Disease, Belarus State Medical University, Belarus), Irith De Baetselier (Antwerp Institute of Tropical Medicine, Belgium), Jack S. Lambert (University College Dublin, Ireland), Jeffrey V. Lazarus (ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - University of Barcelona, Spain), Jens D. Lundgren (Department of Infectious Diseases, University of Copenhagen and Centre of Excellence for Health, Immunity and Infections, Denmark), Jordi Casabona (Center for HIV/STI Epidemiological Studies of Catalonia, Spain), Jürgen Rockstroh (Department of Medicine I, University Hospital Bonn, Germany), Kira Grazava (TB Coalition Europe, Ukraine), Lella Cosmaro (Fondazione LILA Milan, Italy), Liudmyla Maistat (Medicines Patent Pool, Switzerland), Magnus Unemo (WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Örebro University Hospital, Sweden), Mark Vermeulen (Aidsfonds – Soa Aids Nederland, Netherlands), Mojca Matičič (University Medical Centre Ljubljana, Slovenia), Nino Tsereteli (Center for Information and Counselling on Reproductive Health – Tanadgoma, Georgia), Rajul Patel (Department of Genitourinary Medicine, Southampton University Hospitals and International Union against Sexually Transmitted Infections, UK), Tom Platteau (HIV/STI clinic of the Institute of Tropical Medicine in Antwerp, Belgium) and Yazdan Yazdanpanah (INSERM, France).
The EuroTEST Initiative receives funding from Gilead Sciences, Merck MSD, ViiV Healthcare and the ECDC through a framework contract unrelated to the content of this work (ECDC/2021/020). The funders had no input into the content of the manuscript.
© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.