{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T16:38:25Z","timestamp":1781195905213,"version":"3.54.1"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T00:00:00Z","timestamp":1378857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Late presentation to <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">AIDS<\/jats:styled-content> services compromises treatment outcomes and misses opportunities for biomedical and behavioural prevention. There has been significant heterogeneity in how the term \u2018late presentation\u2019 (<jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>) has been used in the literature. In 2011, a consensus definition was reached using <jats:styled-content style=\"fixed-case\">CD4<\/jats:styled-content> counts to define and measure late presenters and, while it is useful for clinical care, the consensus definition has several important limitations that we discuss in this article.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the spectrum of engagement in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> care presented by <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>ardner and colleagues, this article highlights issues and opportunities associated with use of the consensus definition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The consensus definition is limited by three principal factors: (1) the <jats:styled-content style=\"fixed-case\">CD4<\/jats:styled-content> count threshold of 350\u2009cells\/\u03bc<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> is being increasingly questioned as the biomedical justification grows for earlier initiation of treatment; (2) <jats:styled-content style=\"fixed-case\">CD4<\/jats:styled-content> evaluations are conducted at multiple services providing <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> care; thus it remains unclear to which service the patient is presenting late; and (3) the limited availability of <jats:styled-content style=\"fixed-case\">CD4<\/jats:styled-content> evaluation restricts its use in determining the prevalence of <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content> in many settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The consensus definition is useful because it describes the level of disease progression and allows for consistent evaluation of the prevalence and determinants of <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>. Suggestions are provided for improving the application of the consensus definition in future research.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12088","type":"journal-article","created":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T02:35:25Z","timestamp":1378953325000},"page":"130-134","source":"Crossref","is-referenced-by-count":16,"title":["Late presentation to <scp>HIV\/AIDS<\/scp> testing, treatment or continued care: clarifying the use of <scp>CD4<\/scp> evaluation in the consensus definition"],"prefix":"10.1111","volume":"15","author":[{"given":"S","family":"MacCarthy","sequence":"first","affiliation":[{"name":"Alpert Medical School of Brown University and The Miriam Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DR","family":"Bangsberg","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Center for Global Health Harvard Medical School  Boston MA USA"},{"name":"Mbarara University of Science and Technology  Mbarara Mbarara District Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Gruskin","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population  Boston MA USA"},{"name":"Program on Global Health and Human Rights, Institute of Global Health University of Southern California  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq243"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120600966182"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1258\/0956462001916407"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-8-8"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/652650"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-5-6"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181ab6eab"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-416"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2010.00857.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.7.1019"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181ab73e2"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0045692"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir689"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318236f7d2"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328355d67b"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP1522"},{"key":"e_1_2_7_18_1","unstructured":"Department of Health and Human Services.Guidelines for the Use of Antiretroviral Agents in HIV\u20101\u2010Infected Adults and Adolescents. 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