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

Peter D Kirwan; Annemarie R Stengaard; Johanna Brännström; Dominique Van Beckhoven; Ard van Sighem; Eline LM Op de Coul; Barbara Gunsenheimer-Bartmeyer; Uwe Koppe; Helena Cortes-Martins; Vítor Cabral Veríssimo; Marek Malý; Maria Wessman; Chrysa Tsiara; Georgios Ferentinos; Barbara Suligoi; Vincenza Regine; Lucia Pugliese; Sophie Grabar; Ann K Sullivan; Juliana Reyes-Urueña; Anastasia Pharris; Giorgi Kuchukhidze; Ole Kirk; Sara Croxford; Dorthe Raben; on behalf of the EuroTEST HIV Late Diagnosis Definition Working Group and EuroTEST Steering Committee

doi:10.2807/1560-7917.ES.2026.31.32.2500921

Research Open Access

Like 0

Download

Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023
Peter D Kirwan¹ , Annemarie R Stengaard² , Johanna Brännström^3,4,5 , Dominique Van Beckhoven⁶ , Ard van Sighem^7,8 , Eline LM Op de Coul⁹ , Barbara Gunsenheimer-Bartmeyer¹⁰ , Uwe Koppe¹⁰ , Helena Cortes-Martins¹¹ , Vítor Cabral Veríssimo¹² , Marek Malý¹³ , Maria Wessman¹⁴ , Chrysa Tsiara¹⁵ , Georgios Ferentinos¹⁵ , Barbara Suligoi¹⁶ , Vincenza Regine¹⁶ , Lucia Pugliese¹⁶ , Sophie Grabar^17,18 , Ann K Sullivan¹⁹ , Juliana Reyes-Urueña²⁰ , Anastasia Pharris²⁰ , Giorgi Kuchukhidze²¹ , Ole Kirk² , Sara Croxford²² , Dorthe Raben² , on behalf of the EuroTEST HIV Late Diagnosis Definition Working Group and EuroTEST Steering Committee²³
View Affiliations Hide Affiliations

Affiliations: ¹ MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom ² Rigshospitalet, University of Copenhagen, CHIP - Centre of Excellence in Health, Immunity and Infections, Copenhagen, Denmark ³ Department of Infectious Diseases, Södersjukhuset, Stockholm, Sweden ⁴ Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden ⁵ Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden ⁶ Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium ⁷ Stichting HIV Monitoring, Amsterdam, Netherlands ⁸ Amsterdam institute for Immunology & Infectious diseases, Amsterdam, The Netherlands ⁹ National Institute for Public Health and the Environment (Centre for Infectious Disease Control), Bilthoven, Netherlands ¹⁰ Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany ¹¹ National Institute of Health, Lisbon, Portugal ¹² Directorate-General of Health, Lisbon, Portugal ¹³ National Institute of Public Health, Prague, Czech Republic ¹⁴ Statens Serum Institut, Copenhagen, Denmark ¹⁵ National Public Health Organization, Athens, Greece ¹⁶ Istituto Superiore di Sanità, Rome, Italy ¹⁷ Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France ¹⁸ Hôpital St Antoine, Département de Santé Publique, Paris, France ¹⁹ Chelsea & Westminster NHS Foundation Trust, London, United Kingdom ²⁰ European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden ²¹ World Health Organization Regional Office for Europe, Copenhagen, Denmark ²² Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, United Kingdom ²³ The members of these groups are listed under Acknowledgements

Correspondence:
Peter Kirwan
peter.kirwan isglobal.org
View Citation Hide Citation

Citation style for this article: Kirwan Peter D, Stengaard Annemarie R, Brännström Johanna, Van Beckhoven Dominique, van Sighem Ard, Op de Coul Eline LM, Gunsenheimer-Bartmeyer Barbara, Koppe Uwe, Cortes-Martins Helena, Veríssimo Vítor Cabral, Malý Marek, Wessman Maria, Tsiara Chrysa, Ferentinos Georgios, Suligoi Barbara, Regine Vincenza, Pugliese Lucia, Grabar Sophie, Sullivan Ann K, Reyes-Urueña Juliana, Pharris Anastasia, Kuchukhidze Giorgi, Kirk Ole, Croxford Sara, Raben Dorthe, on behalf of the EuroTEST HIV Late Diagnosis Definition Working Group and EuroTEST Steering Committee. Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023. Euro Surveill. 2026;31(32):pii=2500921. https://doi.org/10.2807/1560-7917.ES.2026.31.32.2500921 Received: 05 Dec 2025; Accepted: 15 Jun 2026

SDG 3: HIV/AIDS

Abstract

BACKGROUND

With 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.

AIM

We 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.

METHODS

We 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.

RESULTS

Among 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.

CONCLUSIONS

Without reclassification, late HIV diagnosis proportions are overestimated. We provide recommendations and validity considerations for countries intending to use the revised definition.

This work is licensed under a Creative Commons Attribution 4.0 International License.

Article metrics loading...

/content/10.2807/1560-7917.ES.2026.31.32.2500921

2026-08-13

2026-10-14

Click here for cited by

/content/10.2807/1560-7917.ES.2026.31.32.2500921

Full text loading...

/deliver/fulltext/eurosurveillance/31/32/eurosurv-31-32-3.html?itemId=/content/10.2807/1560-7917.ES.2026.31.32.2500921&mimeType=html&fmt=ahah

References

May M, Gompels M, Delpech V, Porter K, Post F, Johnson M, et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ. 2011;343(oct11 2):d6016. https://doi.org/10.1136/bmj.d6016 PMID: 21990260
Mussini C, Girardi E, Milic J, Guaraldi G, Orkin C. Late HIV diagnosis-a tale of successes and failures. Clin Microbiol Infect. 2025;31(8):1248-50. https://doi.org/10.1016/j.cmi.2025.02.036 PMID: 40043908
Late Presentation Working Groups in EuroSIDA and COHERE. Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010-2016. BMC Infect Dis. 2020;20(1):728. https://doi.org/10.1186/s12879-020-05261-7 PMID: 33028235
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016;375(9):830-9. https://doi.org/10.1056/NEJMoa1600693 PMID: 27424812
European Centre for Disease Prevention and Control (ECDC). European Standards of HIV prevention and care: Module on HIV testing. Stockholm: ECDC; 2025. Available from: https://data.europa.eu/doi/10.2900/2286502
Maartens G, Celum C, Lewin SR. HIV infection: epidemiology, pathogenesis, treatment, and prevention. Lancet. 2014;384(9939):258-71. https://doi.org/10.1016/S0140-6736(14)60164-1 PMID: 24907868
Touloumi G, Pantazis N, Pillay D, Paraskevis D, Chaix M-L, Bucher HC, et al. Impact of HIV-1 subtype on CD4 count at HIV seroconversion, rate of decline, and viral load set point in European seroconverter cohorts. Clin Infect Dis. 2013;56(6):888-97. https://doi.org/10.1093/cid/cis1000 PMID: 23223594
May M, Wood R, Myer L, Taffé P, Rauch A, Battegay M, et al. CD4(+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland. J Infect Dis. 2009;200(11):1729-35. https://doi.org/10.1086/648096 PMID: 19848608
Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 cells/mm³: assessment of need following changes in treatment guidelines. Clin Infect Dis. 2011;53(8):817-25. https://doi.org/10.1093/cid/cir494 PMID: 21921225
European AIDS Clinical Society. EACS Guidelines 12.1. European AIDS Clinical Society; 2024 Nov. [Accessed: 7 Sept 2025]. Available from: https://www.eacsociety.org/guidelines/eacs-guidelines
Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al. Late presentation of HIV infection: a consensus definition. HIV Med. 2011;12(1):61-4. https://doi.org/10.1111/j.1468-1293.2010.00857.x PMID: 20561080
World Health Organization Regional Office for Europe (WHO/Europe), European Centre for Disease Prevention and Control (ECDC). HIV/AIDS surveillance in Europe 2024 – 2023 data. Copenhagen: WHO/Europe, Stockholm: ECDC; 2024. [Accessed: 20 Oct 2025]. Available from:
Freeman-Romilly N, Sheppard P, Desai S, Cooper N, Brady M. Does community-based point of care HIV testing reduce late HIV diagnosis? A retrospective study in England and Wales. Int J STD AIDS. 2017;28(11):1098-105. https://doi.org/10.1177/0956462416688573 PMID: 28118802
Gullón A, Verdejo J, de Miguel R, Gómez A, Sanz J. Factors associated with late diagnosis of HIV infection and missed opportunities for earlier testing. AIDS Care. 2016;28(10):1296-300. https://doi.org/10.1080/09540121.2016.1178700 PMID: 27144427
Croxford S, Stengaard AR, Brännström J, Combs L, Dedes N, Girardi E, et al. Late diagnosis of HIV: An updated consensus definition. HIV Med. 2022;23(11):1202-8. https://doi.org/10.1111/hiv.13425 PMID: 36347523
Sasse A, Florence E, Pharris A, De Wit S, Lacor P, Van Beckhoven D, et al. Late presentation to HIV testing is overestimated when based on the consensus definition. HIV Med. 2016;17(3):231-4. https://doi.org/10.1111/hiv.12292 PMID: 26222266
Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, et al. Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden. HIV Med. 2016;17(6):425-35. https://doi.org/10.1111/hiv.12321 PMID: 26559921
Kirwan PD, Croxford S, Aghaizu A, Murphy G, Tosswill J, Brown AE, et al. Re-assessing the late HIV diagnosis surveillance definition in the era of increased and frequent testing. HIV Med. 2022;23(11):1127-42. https://doi.org/10.1111/hiv.13394 PMID: 36069144
Suligoi B, Regine V, Pugliese L, Galli C. Recent HIV infections in Italy: Data from the HIV national surveillance system, 2012-2023. Pathogens. 2025;14(9):835. https://doi.org/10.3390/pathogens14090835 PMID: 41011735
Statens Serum Institut (SSI). Annual report HIV 2024. Copenhagen: SSI; 2026. [Accessed: 15 May 2026]. Available from: https://en.ssi.dk/surveillance-and-preparedness/surveillance-in-denmark/annual-reports-on-disease-incidence/h/hiv-2024
European Centre for Disease Prevention and Control (ECDC). TESSy metadata report. Stockholm: ECDC. [Accessed: 14 Sep 2025]. Available from: https://www.ecdc.europa.eu/en/publications-data/tessy-metadata-report
European AIDS Clinical Society (EACS). Primary HIV infection (PHI). Brussels: EACS. 2025. [Accessed: 28 Oct 2025]. Available from: https://eacs.sanfordguide.com/en/eacs-hiv/art/eacs-primary-hiv-infection
von Hippel PT. How many imputations do you need? A two-stage calculation using a quadratic rule. Sociol Methods Res. 2020;49(3):699-718. https://doi.org/10.1177/0049124117747303 PMID: 39211325
Sullivan A, van Ahee A, Rae C, Raben D, Combs L, Mason L, et al. Public health guidance on HIV, hepatitis B and C testing in the EU/EEA. An integrated approach. Stockholm: European Centre for Disease Prevention and Control; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/hiv-hep-testing-guidance_0.pdf
Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nöstlinger C, et al. HIV testing within general practices in Europe: a mixed-methods systematic review. BMC Public Health. 2018;18(1):1191. https://doi.org/10.1186/s12889-018-6107-0 PMID: 30348140
European Centre for Disease Prevention and Control (ECDC). HIV and migrants in the EU/EEA - Monitoring the implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2024 progress report (2023 data). Stockholm: ECDC; 2024. Available from:https://www.ecdc.europa.eu/sites/default/files/document s/hiv-migrants-dublin-declaration-november-2024_0.pdf
van Aar F, Schreuder I, van Weert Y, Spijker R, Götz H, Op de Coul E, et al. Current practices of partner notification among MSM with HIV, gonorrhoea and syphilis in the Netherlands: an urgent need for improvement. BMC Infect Dis. 2012;12(1):114. https://doi.org/10.1186/1471-2334-12-114 PMID: 22583517
Suligoi B, Rodella A, Raimondo M, Regine V, Terlenghi L, Manca N, et al. Avidity Index for anti-HIV antibodies: comparison between third- and fourth-generation automated immunoassays. J Clin Microbiol. 2011;49(7):2610-3. https://doi.org/10.1128/JCM.02115-10 PMID: 21543577
European Centre for Disease Prevention and Control (ECDC). Testing of HIV, hepatitis C and hepatitis B in the European Union/European Economic Area (EU/EEA). Stockholm: ECDC; 2025. Available from: https://www.ecdc.europa.eu/en/publications-data/testing-hiv-hepatitis-b-and-hepatitis-c-european-union-european-economic-area
Stengaard AR, Sullivan AK, Simões D, Diderichsen J, Raben D, Rockstroh JK, et al. An overview of consent requirements for HIV and viral hepatitis B and C testing in Europe. HIV Med. 2026;10.1111/hiv.70248. https://doi.org/10.1111/hiv.70248 PMID: 42050980
Owusu MW, Krankowska DC, Lourida P, Weis N. Late HIV diagnosis among migrant women living in Europe - a systematic review of barriers to HIV testing. IJID Reg. 2023;7:206-15. https://doi.org/10.1016/j.ijregi.2023.03.006 PMID: 37128290
Slurink IAL, van de Baan F, van Sighem AI, van Dam AP, van de Laar TJW, de Bree GJ, et al. Monitoring recently acquired HIV infections in Amsterdam, the Netherlands: The attribution of test locations. Front Reprod Health. 2021;3:568611. https://doi.org/10.3389/frph.2021.568611 PMID: 36304001
Goedert JJ. Prognostic markers for AIDS. Ann Epidemiol. 1990;1(2):129-39. https://doi.org/10.1016/1047-2797(90)90004-C PMID: 1669494

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

Citation style for this article: <a href="/search?value1=Peter+D+Kirwan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kirwan Peter D</a>, <a href="/search?value1=Annemarie+R+Stengaard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stengaard Annemarie R</a>, <a href="/search?value1=Johanna+Br%C3%A4nnstr%C3%B6m&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brännström Johanna</a>, <a href="/search?value1=Dominique+Van+Beckhoven&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van Beckhoven Dominique</a>, <a href="/search?value1=Ard+van+Sighem&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Sighem Ard</a>, <a href="/search?value1=Eline+LM+Op+de+Coul&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Op de Coul Eline LM</a>, <a href="/search?value1=Barbara+Gunsenheimer-Bartmeyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gunsenheimer-Bartmeyer Barbara</a>, <a href="/search?value1=Uwe+Koppe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koppe Uwe</a>, <a href="/search?value1=Helena+Cortes-Martins&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cortes-Martins Helena</a>, <a href="/search?value1=V%C3%ADtor+Cabral+Ver%C3%ADssimo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Veríssimo Vítor Cabral</a>, <a href="/search?value1=Marek+Mal%C3%BD&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Malý Marek</a>, <a href="/search?value1=Maria+Wessman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wessman Maria</a>, <a href="/search?value1=Chrysa+Tsiara&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tsiara Chrysa</a>, <a href="/search?value1=Georgios+Ferentinos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ferentinos Georgios</a>, <a href="/search?value1=Barbara+Suligoi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Suligoi Barbara</a>, <a href="/search?value1=Vincenza+Regine&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Regine Vincenza</a>, <a href="/search?value1=Lucia+Pugliese&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pugliese Lucia</a>, <a href="/search?value1=Sophie+Grabar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Grabar Sophie</a>, <a href="/search?value1=Ann+K+Sullivan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sullivan Ann K</a>, <a href="/search?value1=Juliana+Reyes-Urue%C3%B1a&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reyes-Urueña Juliana</a>, <a href="/search?value1=Anastasia+Pharris&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pharris Anastasia</a>, <a href="/search?value1=Giorgi+Kuchukhidze&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuchukhidze Giorgi</a>, <a href="/search?value1=Ole+Kirk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kirk Ole</a>, <a href="/search?value1=Sara+Croxford&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Croxford Sara</a>, <a href="/search?value1=Dorthe+Raben&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raben Dorthe</a>, <a href="/search?value1=on+behalf+of+the+EuroTEST+HIV+Late+Diagnosis+Definition+Working+Group+and+EuroTEST+Steering+Committee&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the EuroTEST HIV Late Diagnosis Definition Working Group and EuroTEST Steering Committee</a>. Multi-country study on the impact of a revised consensus definition of late HIV diagnosis, Europe, 2022 to 2023. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(32):pii=2500921. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.32.2500921" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.32.2500921</a> Received: 05 Dec 2025;   Accepted: 15 Jun 2026

/content/10.2807/1560-7917.ES.2026.31.32.2500921

Data & Media loading...

Supplementary data

Download
- Supplement

Submit comment

Comment moderation successfully completed

Submit your article here

Submit an Article

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

Abstract

Click here for cited by

Supplementary data

Supplement