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Efforts to ensure earlier diagnosis of HIV infection across Europe are still needed


Late diagnosis of HIV infection and entry into care remains a substantial problem across Europe according to a study published in this week's PLOS Medicine. The study, which was an international collaboration led by Amanda Mocroft from University College London, UK, analysed data from the COHERE in EuroCOORD study, an international collaboration including over 84,000 individuals with HIV infections from 35 European countries from January 2000 to January 2011.

The researchers analysed data from over 20 observational studies from across Europe that contribute data to the COHERE collaboration and found that nearly 54% of the participants diagnosed with HIV presented late to a clinic, that is they had a CD4 count of less than 350 cells/mm3 (a measure of white blood cells used to monitor HIV infection) or an AIDS-defining illness within 6 months of HIV diagnosis within the time period studied.

Diagnosis of HIV infection and receiving care as soon as possible after becoming infected with HIV is important for patients because individuals who receive anti-retroviral drugs, which can control but not cure HIV, and counselling earlier have better health outcomes. Individuals who are receiving treatment that reduces the amount HIV virus in their system are also less likely to pass on the virus.

Although researchers found that late presentation overall decreased from 57.3% in 2000 to 51.7% in 2010/11, in some populations, such as injection drug users in Southern Europe, late presentation increased. Late presentation was found to be associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, although this also varied across Europe. They also found that less than 10% of individuals had delayed entry into care after diagnosis, although this information was only available for a minority of patients.

The authors note, "while late presentation has decreased over time across Europe, it remains a significant issue across the European continent with implications for both individuals and the public health in most European regions."

The authors conclude, "[i]t is important that earlier HIV testing strategies are targeted to all populations at risk both within the health care system and in community based programs, to ensure timely referrals after testing positive, improved retention in care strategies, and optimal clinical management and initiation of ART in those testing HIV positive."


Funding: The COHERE study group has received generic funding from Agence Nationale de Recherches sur le SIDA et les He´patites Virales (ANRS), France; HIV Monitoring Foundation, The Netherlands; and the Augustinus Foundation, Denmark. COHERE receives funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement nu 260694. A list of the funders of the participating cohorts can be found on the COHERE website at The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: AM has received lecture fees, honoraria, and/or consultancies from Pfizer, BI, BMS, Merck, and Gilead. Ad'A is an advisory board member of BMS, Jannsen, Gilead, and ViiV. GF has received honoraria for lectures and advisory boards from Abbott, Bristol-Myers Squibb, Gilead, Janssen-Cilag, and Merck Sharp & Dohme. Research grant to GF from the German Federal Ministry of Education and Research (BMBF) 01KI1017. AJ is a Governor of the Wellcome Trust, a charitable research funding body; in 2011 was a specialist adviser to House of Lords Select Committee on HIV/AIDS; is a member of the UK Expert Advisory Group on AIDS; receives research grant funding from the UK Medical Research Council, Wellcome Trust, UK National Institute for Health Research, and Department of Health. CL has received these research grants: ANRS CMIT soutien (Aproco-Copilote ANRS CO08 HIV cohort, 1997-2012); IMMI (Cohort Fluco A(H1N1) pandemic influenza, 2009-2012); Ministe`re de la Sante´ PHRC (Bivir influenza trial, Oseltamivir Zanamivir, 2006-2012). CS has received funding for Advisory Board membership, speaker panels, and provision of educational materials for Gilead Sciences, Abbott Pharmaceuticals, ViiV, Merck Sharp & Dohme, Janssen-Cilag, and Bristol-Myers Squibb. CT has received honoraria to act as speaker at CME conferences on antiretroviral therapy and HIV disease management from several companies producing antiretroviral drugs, received travel grants to participate in scientific conferences, and acted as scientific consultant for the same companies. GC has had scientific responsibilities in projects receiving specific grant support from the French Agency for Research on AIDS and Viral Hepatitis (ANRS), the European Commission (Framework Program 7), UK Medical Research Council, US National Institute of Health (NIH), Fondation Plan Alzheimer, Gilead, Tibotec, Boehringer Ingelheim, GlaxoSmithKline, Roche, Pfizer, Merck, Abbott, Bristol-Myers Squibb, Janssen, ViiV Healthcare - these grants are managed through her Institution or a non-profit society. GC also serves as Academic Editor on PLOS ONE and is on the editorial board of the BMC Infectious Diseases Journal. OK has received honoraria, consultancy, lecture fees, and travel grants from Abbott Laboratories, Bristol Myers Squibb, Gilead Sciences, Janssen, Merck Sharp & Dohme, Roche, and ViiV Healthcare, and has served/is serving on Advisory Boards for Gilead Sciences, Merck Sharp & Dohme, and ViiV Healthcare. No other competing interests have been declared.

Citation: Mocroft A, Lundgren JD, Sabin ML, Monforte Ad, Brockmeyer N, et al. (2013) 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 Med 10(9): e1001510. doi:10.1371/ journal.pmed.1001510



Amanda Mocroft
University College London Medical School
+44 1730 890194 or +44 2077940500 ext 33194

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