Characteristics of late HIV diagnosis in Germany in 2019 and 2020 - A regional analysis

A large proportion of HIV diagnoses are made at an advanced stage of infection and different patient characteristics have been associated with late diagnosis of HIV. This study aims to assess the prevalence of late HIV diagnosis, to characterize individuals diagnosed at a late stage of infection and to evaluate regional differences in Germany.

This retrospective, cross-sectional analysis included 1,169 individuals newly diagnosed with HIV in 2019 and 2020. Data on patient demographics, information on the HIV diagnosis and laboratory parameters were collected. Late diagnosis and advanced HIV disease were defined according to established consensus criteria. Regional comparison was made between eastern and western Germany.

In our cohort, 82.6% of the individuals were male and 16.9% female, with a median age of 39 years (IQR: 31-50). The prevalence of late diagnosis was 61.6% and advanced HIV disease, as a subgroup of late diagnosis, was present in 41.7%. Individuals with late diagnosis were significantly older than those diagnosed at an earlier stage (p < 0.001). Patients in eastern Germany were diagnosed at more advanced stages of infection with significantly higher rates of late diagnosis (p < 0.01), advanced HIV disease (p < 0.001), and AIDS-defining conditions (p < 0.001), as well as significantly lower CD4 cell counts (p < 0.001).

Our data demonstrate that a high proportion of HIV diagnoses in Germany are made at a late stage of infection. Late diagnosis was more frequent in older individuals and in those living in eastern Germany. These findings highlight the need for strengthened HIV testing strategies, particularly in underserved populations and regions.