Late HIV diagnosis in Europe: a call for increased testing and awareness among general practitioners

Major advancements in the treatment of HIV infection mean near normal life expectancy of persons diagnosed at an early stage of infection. Nevertheless, a significant proportion of HIV infected persons remain undiagnosed and are diagnosed at a late stage of infection, putting them at higher risk for preventable HIV-related morbidity and mortality and risking onward transmission to others. In Europe, half of people diagnosed with HIV in 2010 were diagnosed late with a CD4<350 cells/ul, at a point after which treatment should have begun. The causes of late diagnosis are manifold, and comprise barriers to testing at the patient, healthcare provider, and institutional level. Strategies to address barriers to HIV testing are essential to ensure prompt diagnosis. Routine universal HIV testing in general practice consisting of informed consent and a pre-test discussion is feasible and acceptable and should be considered in high prevalence areas to normalize HIV testing, reduce stigma, and reduce the number of infected individuals who are diagnosed late.