Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023

BACKGROUNDWith improvements in test sensitivity and testing frequency, more people in Europe are diagnosed during the HIV acute/seroconversion phase, when their CD4+ T-cell count can be temporarily low.AIMWe piloted a revised definition of late HIV diagnosis for surveillance which considers laboratory markers, evidence of HIV test negativity in the past year and clinical evidence of recent HIV acquisition, to better distinguish between people diagnosed late and those diagnosed during the acute/seroconversion phase.METHODSWe collected pseudonymised HIV diagnosis records for 2022 and 2023 from nine European countries (Belgium, Czechia, Denmark, Germany, Greece, Italy, the Netherlands, Portugal and Sweden). We applied the revised definition to reclassify those with evidence of recently acquired HIV as 'not late' and calculated the corresponding correction factor by country and demographic group. Individuals with a previous diagnosis were excluded from the analysis.RESULTSAmong 10,220 individuals with a CD4+ T-cell count at diagnosis, 56% (5,689/10,220) had a CD4+ T-cell count < 350 cells/µL or an AIDS-defining event at diagnosis. Applying the revised definition reduced the late diagnosis proportion from 56% to 50%, a correction factor of 9% (535/5,689). The correction factor ranged between 3% and 25% across countries and was higher for younger ages and for gay, bisexual and other men who have sex with men, compared with other groups.CONCLUSIONSWithout reclassification, late HIV diagnosis proportions are overestimated. We provide recommendations and validity considerations for countries intending to use the revised definition.

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Publication Details

Journal
Eurosurveillance
Published
2026-08-13
DOI
https://doi.org/10.2807/1560-7917.es.2026.31.32.2500921
Primary Topic
HIV Research and Treatment
Type
article
Field-Weighted Citation Impact
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article

Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023

Helena Cortes Martins, Sara Croxford, Marek Malý, Eline Op de Coul et al.
Eurosurveillance
HIV Research and Treatment
article

Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023

Helena Cortes Martins, Sara Croxford, Marek Malý, Eline Op de Coul, Ann Sullivan, Vincenza Règine, Ole Kirk, Peter Kirwan, Johanna Brännström, Uwe Koppe, Chrysa Tsiara, Ard van Sighem, Barbara Suligoi, Vítor Cabral Veríssimo, Georgios Ferentinos, Dominique Van Beckhoven, Sophie Grabar, Lucia Pugliese, Maria Wessman, Giorgi Kuchukhidze, Dorthe Raben, A. Rinder Stengaard, Juliana Reyes‐Urueña, Anastasia Pharris, Barbara Gunsenheimer-Bartmeyer
article en

Abstract

BACKGROUNDWith improvements in test sensitivity and testing frequency, more people in Europe are diagnosed during the HIV acute/seroconversion phase, when their CD4+ T-cell count can be temporarily low.AIMWe piloted a revised definition of late HIV diagnosis for surveillance which considers laboratory markers, evidence of HIV test negativity in the past year and clinical evidence of recent HIV acquisition, to better distinguish between people diagnosed late and those diagnosed during the acute/seroconversion phase.METHODSWe collected pseudonymised HIV diagnosis records for 2022 and 2023 from nine European countries (Belgium, Czechia, Denmark, Germany, Greece, Italy, the Netherlands, Portugal and Sweden). We applied the revised definition to reclassify those with evidence of recently acquired HIV as 'not late' and calculated the corresponding correction factor by country and demographic group. Individuals with a previous diagnosis were excluded from the analysis.RESULTSAmong 10,220 individuals with a CD4+ T-cell count at diagnosis, 56% (5,689/10,220) had a CD4+ T-cell count < 350 cells/µL or an AIDS-defining event at diagnosis. Applying the revised definition reduced the late diagnosis proportion from 56% to 50%, a correction factor of 9% (535/5,689). The correction factor ranged between 3% and 25% across countries and was higher for younger ages and for gay, bisexual and other men who have sex with men, compared with other groups.CONCLUSIONSWithout reclassification, late HIV diagnosis proportions are overestimated. We provide recommendations and validity considerations for countries intending to use the revised definition.

EurosurveillanceVol. 31(32)
Statens Serum Institut (DK), Lancashire Teaching Hospitals NHS Foundation Trust (GB), Inserm (FR), University of Cambridge (GB), Robert Koch Institute (DE), Istituto Superiore di Sanità (IT), Chelsea and Westminster Hospital NHS Foundation Trust (GB), Karolinska Institutet (SE), Sorbonne Université (FR), Netherlands Center for Occupational Diseases (NL), Stockholm South General Hospital (SE), World Health Organization Regional Office for Europe (DK), Hôpital Saint-Antoine (FR), National Institute for Public Health and the Environment (NL), Stichting HIV Monitoring (NL), Institut Pierre Louis d‘Épidémiologie et de Santé Publique (FR), MRC Biostatistics Unit (GB), National Institute of Public Health (CZ), Direção Geral do Território (PT), National Institute of Health Dr. Ricardo Jorge (PT), Sciensano (Belgium) (BE), National Public Health Organization (GR), Centre of Excellence for Health, Immunity and Infections (DK), European Centre for Disease Prevention and Control (SE)
Good health and well-being
Openalex Percentile: Top 11%
HIV Research and Treatment
DOIOpen Access PDFOpenAlex
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