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Late diagnosis of HIV infection significant issue across Europe

Friday, 6 September, 2013

Late presentation of HIV infection remains a significant issue across the European continent, despite marked improvements in recent years. According to research published in PLOS Medicine this week, late diagnosis decreased from 57.3 percent in 2000, to 51.7 percent in 2010/2011, across the whole continent. Nevertheless, there were regional variations, and pockets of populations have experienced increases in late presentation of infection, including injecting drug users (IDUs) and female heterosexuals in Southern Europe, and IDUs in Eastern Europe, to name a few. 

Late presentation of HIV occurs when people are newly diagnosed at a late stage of infection, defined as having a CD4 count below 350 cells/mm3, or as having an AIDS-defining illness within 6 months of diagnosis. Being diagnosed late with HIV can increase the risk of AIDS-related deaths, because antiretroviral treatment (ART) is less likely to work as effectively. Being diagnosed early is also important from a prevention point of view - this is because people who are aware of their diagnosis are more likely to take measures to ensure they do not infect others. From a public health perspective, if people are on treatment, they can maintain a low enough viral load that they are less likely to transmit the virus to others.

The study included 84,524 individuals, from 35 countries, over a ten-year period. It found that people diagnosed late with HIV infection, had a higher mortality rate, especially in the first two years after diagnosis. The groups that had the highest incidence of late presentation over the entire period were heterosexual males (66.1 percent), individuals of African origin (65.1 percent and Southern European countries (57 percent). The authors noted that men who have sex with men (MSM) across the continent have witnessed decreases in late diagnosis, as have male and female heterosexuals in Central and Northern Europe. IDUs continue to remain an at-risk group for late presentation, particularly in Eastern Europe.

The authors stated: “increasing awareness of HIV risk factors increased opportunities for testing, reducing barriers to testing, and increasing the availability of effective ART will help address ongoing HIV transmission across Europe, and especially in Eastern Europe, where the number of newly diagnosed infections continues to be very high.” They conclude that testing strategies should be targeted at high-risk populations, through both the health care system and community-based programmes, to ensure timely diagnosis and retention of care.