title: Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden.
abstract: The aim of the study was to identify factors in HIV-infected patients and the health care system which contribute to late diagnosis.
  
  
  
  All patients who were newly diagnosed with HIV infection at 12 clinics in Sweden over a period of 2.5 years (n = 575) were included in the study, corresponding to three-quarters of newly diagnosed HIV infections in the country. The patients were classified as non-late presenters or late presenters (LPs), defined as those with a CD4 count < 350 cells/μL or AIDS. LPs were subdivided into those without and those with advanced HIV disease, which was defined as a CD4 count < 200 cells/μL or AIDS. Demographics, missed AIDS and HIV-associated symptoms in the preceding 3 years, immigration date, and health examination at immigration were recorded.
  
  
  
  Fifty-eight per cent of the patients were LPs, of whom 66% had advanced disease. Age > 30 years, origin in sub-Saharan Africa or Eastern Europe/Asia/the Pacific region, and country of transmission being in sub-Saharan Africa or unknown were associated with late presentation. Half of the patients of non-Swedish origin had lived for more than 1 year in Sweden at diagnosis and 66% had a missed HIV testing opportunity at immigration. Twenty-seven per cent of all patients had presented for health care with AIDS- and/or HIV-associated conditions without having an HIV test. Sixteen per cent had a history of symptoms without seeking care.
  
  
  
  Deficiencies in the health care system with missed HIV testing opportunities contribute to the high proportion of late presenters in Sweden, especially among migrants. With increased testing at immigration and further incorporation of "indicator-guided" testing in general practice, most patients could be diagnosed earlier.
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: J
authors.identifier: 0000-0001-7684-8591
authors.initials: J
authors.lastname: Brännström
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Svedhem Johansson
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Marrone
authors.affiliation: Department of Infectious Diseases, Sunderbyn Hospital, Luleå, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Wendahl
authors.affiliation: Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Yilmaz
authors.affiliation: Department of Clinical Science and Education, Venhälsan, South General Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Blaxhult
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.|Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sönnerborg
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
keywords: Delayed Diagnosis; HIV Infections/*diagnosis/epidemiology; Late HIV diagnosis; Late Presenter; Migrants