Late Presentation and Diagnosis of HIV Infection

Late presentation of HIV infection refers to individuals who first seek care with advanced immunodeficiency, typically defined by a CD4+ T-cell count below 350 cells/µl or the presence of an AIDS-defining event at diagnosis. Despite dramatic improvements in global testing coverage and treatment access, late presentation remains a persistent obstacle to optimal patient outcomes and to the public-health goal of controlling onward transmission. Individuals who present late experience higher rates of opportunistic infections, increased early mortality and prolonged periods of untreated viraemia, which fuel ongoing spread. Key drivers include limited risk perception, stigma and social barriers, missed opportunities for testing in routine care, and inequities in access among marginalised groups. Recent work has emphasised the need for diverse approaches—ranging from universal test-and-treat strategies and provider-initiated testing in acute-care settings to community-based outreach and self-testing—to ensure earlier diagnosis and rapid linkage to antiretroviral therapy. Advances in point-of-care diagnostics, refined case‐finding algorithms and data-driven targeting of high-risk communities are reshaping efforts to reduce the burden of late presentation.

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Late Presentation and Diagnosis of HIV Infection publication trend

The graph below shows the total number of articles in late presentation and diagnosis of hiv infection across all publications each year (not limited to Nature Index journals).

Technical terms

CD4+ T-cell count: A laboratory measure of helper T lymphocytes per microlitre of blood, used to stage immune suppression in HIV infection.

Viral load: The quantity of HIV RNA copies per millilitre of plasma, serving as a marker of active replication and treatment efficacy.

Late presentation: Initial engagement in HIV care with a CD4+ T-cell count below a predefined threshold (usually 350 cells/µl) or the occurrence of an AIDS-defining event at diagnosis.

Antiretroviral therapy (ART): Combination drug regimens that inhibit distinct stages of the HIV lifecycle to suppress viral replication and restore immune function.

Immune reconstitution inflammatory syndrome (IRIS): An inflammatory response that can follow ART initiation in patients with very low baseline CD4+ counts, sometimes unmasking subclinical infections.

References

1. A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naïve patients with advanced HIV infection in Nanjing, China. Frontiers in Immunology (2023).
2. Universal HIV testing and the impact of late diagnosis on disease stage among adults in urban Ethiopia. Tropical Medicine and Health (2023).
3. Association of demographics, HCV co‐infection, HIV‐1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV‐1 Surveillance Network. Journal of the International AIDS Society (2023).
4. Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLOS Medicine (2013).
5. Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis. PLOS ONE (2017).
6. Missed opportunities for HIV testing in newly-HIV-diagnosed patients, a cross sectional study. BMC Infectious Diseases (2013).