Late Diagnosis of HIV: An Updated Consensus Definition

Sara Croxford; Annemarie Rinder Stengaard; Johanna Brännström; Lauren Combs; Nikos Dedes; Enrico Girardi; Sophie Grabar; Ole Kirk; Giorgi Kuchukhidze; Jeffrey V. Lazarus; Teymur Noori; Anastasia Pharris; Dorthe Raben; Jürgen K. Rockstroh; Daniel Simões; Ann K. Sullivan; Dominique Van Beckhoven; Valerie C. Delpech


HIV Medicine. 2022;23(11):1202-1208. 

In This Article

Abstract and Introduction


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.


Late HIV diagnosis is associated with poor outcomes, an increased risk of ongoing HIV transmission and high healthcare costs.[1,2] As such, late diagnosis remains a key public health metric in assessing the success of HIV testing programmes. In 2010, a consensus statement was published in which late presentation of HIV was defined as presenting for HIV care having a CD4 count < 350 cells/μL or with an AIDS-defining event.[3] This definition was endorsed by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe and has been used across Europe for clinical research and public health monitoring for more than 10 years. Completeness of HIV surveillance data on CD4 count at diagnosis is now high for most countries reporting to the ECDC and WHO.[4]

In recent years, testing for HIV has expanded and frequency has increased across some populations and regions, particularly in relation to the roll-out of pre-exposure prophylaxis (PrEP) programmes. This has resulted in an increasing number of people, particularly men who have sex with men (MSM), being diagnosed with HIV during seroconversion, when their CD4 count may be temporarily low, (known as the 'seroconversion effect').[5,6] Using the current definition of late HIV presentation, these individuals are incorrectly assigned as being diagnosed late. This issue of overestimation has already been raised by research groups in Belgium,[7] Sweden[8] and the UK.[9] This has led to correction factors being applied to the late diagnosis rate of specific subgroups. The magnitude of these correction factors depends on the reclassification criteria, population, country, and study period, but was estimated to be as high as 9% in Belgium.[7]

Therefore, a working group established under the EuroTEST Initiative, with the support of the ECDC, WHO Regional Office for Europe and European AIDS Clinical Society (EACS), decided to revisit this definition, reviewing the feasibility of incorporating data on markers of recent infection to enable better distinction between people diagnosed with HIV late and people recently acquiring HIV.