{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:58:13Z","timestamp":1791849493648,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,11,11]],"date-time":"2015-11-11T00:00:00Z","timestamp":1447200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Swedish National Board of Health and Welfare"},{"DOI":"10.13039\/501100010686","name":"Public Health Agency of Sweden","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010686","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]},{"name":"AIDS Foundation"},{"name":"Swedish Society of Infectious Diseases and Gilead Science Nordic"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The aim of the study was to identify factors in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected patients and the health care system which contribute to late diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients who were newly diagnosed with <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infection at 12 clinics in Sweden over a period of 2.5 years (<jats:italic>n<\/jats:italic> = 575) were included in the study, corresponding to three\u2010quarters of newly diagnosed <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infections in the country. The patients were classified as non\u2010late presenters or late presenters (<jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s), defined as those with a <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count &lt; 350 cells\/\u03bcL or <jats:styled-content style=\"fixed-case\">AIDS<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s were subdivided into those without and those with advanced <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> disease, which was defined as a <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count &lt; 200 cells\/\u03bcL or <jats:styled-content style=\"fixed-case\">AIDS<\/jats:styled-content>. Demographics, missed <jats:styled-content style=\"fixed-case\">AIDS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010associated symptoms in the preceding 3 years, immigration date, and health examination at immigration were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010eight per cent of the patients were <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s, of whom 66% had advanced disease. Age &gt; 30 years, origin in sub\u2010Saharan Africa or Eastern Europe\/Asia\/the Pacific region, and country of transmission being in sub\u2010Saharan Africa or unknown were associated with late presentation. Half of the patients of non\u2010Swedish origin had lived for more than 1 year in Sweden at diagnosis and 66% had a missed <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing opportunity at immigration. Twenty\u2010seven per cent of all patients had presented for health care with <jats:styled-content style=\"fixed-case\">AIDS<\/jats:styled-content>\u2010 and\/or <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010associated conditions without having an <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> test. Sixteen per cent had a history of symptoms without seeking care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Deficiencies in the health care system with missed <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing opportunities contribute to the high proportion of late presenters in Sweden, especially among migrants. With increased testing at immigration and further incorporation of \u201cindicator\u2010guided\u201d testing in general practice, most patients could be diagnosed earlier.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12321","type":"journal-article","created":{"date-parts":[[2015,11,12]],"date-time":"2015-11-12T00:24:44Z","timestamp":1447287884000},"page":"425-435","source":"Crossref","is-referenced-by-count":47,"title":["Deficiencies in the health care system contribute to a high rate of late <scp>HIV<\/scp> diagnosis in Sweden"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7684-8591","authenticated-orcid":false,"given":"J","family":"Br\u00e4nnstr\u00f6m","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases Department of Medicine, Huddinge Karolinska Institute Stockholm Sweden"},{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Svedhem Johansson","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases Department of Medicine, Huddinge Karolinska Institute Stockholm Sweden"},{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Marrone","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases Department of Medicine, Huddinge Karolinska Institute Stockholm Sweden"},{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Wendahl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sunderbyn Hospital Lule\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Blaxhult","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education Venh\u00e4lsan South General Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"S\u00f6nnerborg","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases Department of Medicine, Huddinge Karolinska Institute Stockholm Sweden"},{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Division of Clinical Microbiology Department of Laboratory Medicine Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000286597.57066.2b"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckm117"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e3282f2d8fb"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120802183537"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP1525"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.11.106"},{"key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/QAD.0b013e328333fa0f","article-title":"Late diagnosis in the HAART era: proposed common definitions and associations with mortality","volume":"24","author":"Sabin CA","year":"2010","journal-title":"AIDS"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2010.00857.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001510"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2008.00584.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12022"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052845"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-12-72"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365548.2011.626440"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP1523"},{"key":"e_1_2_6_17_1","first-page":"296","article-title":"Therapy may explain recent deficits in AIDS incidence","volume":"3","author":"Gail MH","year":"1990","journal-title":"J Acquir Immune Defic Syndr"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000233579.79714.8d"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32833f9e1d"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1258\/095646205774357262"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP1883"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-11"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2011.011280"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2011.00958.x"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500060023008"},{"key":"e_1_2_6_26_1","unstructured":"UNAIDS. Available fromhttp:\/\/www.unaids.org\/en\/regionscountries\/regions\/2013. (accessed 30 10 2012)."},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283578b80"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2009.00810.x"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-281"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32833c7b9c"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051312"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhiv.12321","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.12321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T16:01:26Z","timestamp":1695571286000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.12321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,11]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["10.1111\/hiv.12321"],"URL":"https:\/\/doi.org\/10.1111\/hiv.12321","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,11]]}}}