{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:57:05Z","timestamp":1791295025785,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI152897"],"award-info":[{"award-number":["R01AI152897"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI087520"],"award-info":[{"award-number":["R01AI087520"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2018\u201002714"],"award-info":[{"award-number":["2018\u201002714"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Late diagnosis (LD) of HIV, defined as CD4 count &lt;350 cells\/\u03bcL or AIDS at diagnosis, remains a substantial public health challenge, with half of individuals in Europe diagnosed late. How long these individuals have lived with HIV remains unclear. We applied a multi\u2010biomarker model (MBM) to estimate the time since infection (ETI) in newly diagnosed individuals classified as LD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective cohort study of newly diagnosed people with HIV in Sweden between November 2017 and December 2022. Individuals were classified as LD or non\u2010LD according to an updated consensus definition. We applied an MBM combining CD4 count,\n                      <jats:italic>pol<\/jats:italic>\n                      polymorphism counts,\n                      <jats:italic>pol<\/jats:italic>\n                      next\u2010generation sequencing diversity, HIV\u20101 limiting\u2010antigen avidity assay and last negative HIV test to probabilistically derive ETI distributions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More than half (52.4%) were classified as LD. Risk factors for LD included age &gt;50\u2009years (adjusted odds ratio (aOR) 2.94, 95% CI 1.42\u20136.09), origin in Asia and Pacific (aOR 4.53, 95% CI 1.81\u201311.32) and HIV acquisition in Asia and Pacific (aOR 2.28, 95% CI 1.08\u20134.83). Men who have sex with men had reduced risk of LD versus persons with heterosexual acquisition (aOR 0.38, 95% CI 0.22\u20130.64). ETI in 344 individuals revealed diagnostic delays; 41% (95% CrI 36.7\u201346.0) were diagnosed within 1\u2009year: 71% of non\u2010LDs (CrI 95% 65.0\u201377.7) versus 12% of LDs (95% CrI 8.4\u201316.2). Among LDs, over 60% remained undiagnosed beyond 3\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multi\u2010biomarker ETI reveals that most HIV\u20101 infections remain undiagnosed for over 1\u2009year. The updated LD definition correlates better with time since infection and ETI distributions show substantial diagnostic delays. Expanded testing strategies targeting heterosexual and older populations are urgently needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70314","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:08:11Z","timestamp":1791292091000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond\n                    <scp>CD4<\/scp>\n                    counts: Multi\u2010biomarker assessment of estimated time since\n                    <scp>HIV<\/scp>\n                    \u20101 infection and risk factors for late diagnosis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0965-4934","authenticated-orcid":false,"given":"Kathleen","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education (KIS\u00d6S) Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macauley","family":"Locke","sequence":"additional","affiliation":[{"name":"Theoretical Biology &amp; Biophysics Group, Los Alamos National Laboratory  Los Alamos New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmi","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Clinical Microbiology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3198-6400","authenticated-orcid":false,"given":"Sandra","family":"Broddesson","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Tumor and Cell Biology Karolinska Institutet  Stockholm 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Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9020-0521","authenticated-orcid":false,"given":"Jan","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Microbiology, Tumor and Cell Biology Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8160-2588","authenticated-orcid":false,"given":"Thomas","family":"Leitner","sequence":"additional","affiliation":[{"name":"Theoretical Biology &amp; Biophysics Group, Los Alamos National Laboratory  Los Alamos New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7684-8591","authenticated-orcid":false,"given":"Johanna","family":"Br\u00e4nnstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases 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