{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:56:55Z","timestamp":1789729015509,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":195,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R25MH087222"],"award-info":[{"award-number":["R25MH087222"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["AIDS Research and Treatment"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced HIV disease (AHD) remains a major contributor to HIV\u2010related morbidity and mortality. While HIV screening strategies in Brazil emphasize populations traditionally considered at high risk, a significant number of individuals without previous HIV infection present with AHD despite lacking recognized risk profiles. This study aimed to define the sociodemographic and behavioral characteristics of patients presenting with advanced HIV at diagnosis, with the goal of identifying gaps in current HIV screening efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of patients hospitalized in the infectious diseases ward of a tertiary referral hospital between January 2015 and December 2024. We included individuals previously unaware of their HIV status who met World Health Organization (WHO) criteria for AHD, defined as CD4 count &lt;\u2009200\u2009cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      and\/or a WHO Clinical Stage 3 or 4 condition. Sociodemographic characteristics, behavioral risk factors, and clinical data were abstracted from medical records and standardized epidemiologic intake forms. Descriptive analyses compared characteristics across sexuality and gender groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1615 unique patients hospitalized with AHD, 407 (25%) were newly diagnosed with HIV during hospitalization. The median CD4 count at diagnosis was 53\u2009cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      (IQR 27\u2013110), reflecting profound immunosuppression. Most patients identified as heterosexual men (49%), while only 10% identified as sexual or gender minorities. Fewer than one\u2010quarter (24%) had psychosocial risk factors commonly emphasized in HIV screening strategies. Heterosexual men were predominantly employed, married or partnered, and had children, while women and sexual and gender minority patients were older and younger, respectively, and reported fewer risk factors. Injection drug use history and homelessness were rare across all groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AHD at first diagnosis was not concentrated within traditionally recognized high\u2010risk populations. The diversity of patients presenting with AHD at first diagnosis suggests that reliance solely on traditional risk\u2010based screening strategies may be insufficient to ensure timely detection. Expanded routine, opt\u2010out HIV testing across healthcare settings, as well as indicator\u2010based testing, self\u2010testing, and pharmacy\u2010based testing may help reduce missed opportunities for diagnosis and prevent severe immunosuppression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/arat\/6671976","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:27:15Z","timestamp":1784179635000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Advanced HIV Disease at First Diagnosis in South Brazil Extended Beyond Traditionally Targeted Populations: A 10\u2010Year Hospital\u2010Based Study (2015\u20132024)"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6478-7856","authenticated-orcid":false,"given":"Christopher Justin","family":"Hernandez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3050-4202","authenticated-orcid":false,"given":"Pedro Moreno","family":"Fonseca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andressa","family":"Noal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Zywica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2527-2574","authenticated-orcid":false,"given":"Mary Catherine","family":"Cambou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana Ros\u00e2ngela dos Santos","family":"Varella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breno Riegel","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marineide Gon\u00e7alves de","family":"Melo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-5211","authenticated-orcid":false,"given":"Karin","family":"Nielsen-Saines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_12_1_2","volume-title":"Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy","year":"2017"},{"key":"e_1_2_12_2_2","volume-title":"The Stages of HIV Infection","year":"2026"},{"key":"e_1_2_12_3_2","volume-title":"HIV-Related Conditions","year":"2026"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000960"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d6016"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2007.0217"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2313777"},{"key":"e_1_2_12_9_2","volume-title":"HIV and AIDS Epidemiological Bulletin 2024","year":"2024"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1590\/1980-549720230002"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-06764-6"},{"key":"e_1_2_12_12_2","volume-title":"Technical Manual for the Diagnosis of HIV Infection in Adults and Children","year":"2018"},{"key":"e_1_2_12_13_2","volume-title":"Laboratory Examination Control System (SISCEL)","year":"2026"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.13425"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1590\/S2237-96222025v34e20240014.en"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.17058\/reci.v14i1.18843"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2006.088492"},{"key":"e_1_2_12_18_2","unstructured":"BidinottoA. 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Self-Perception of HIV Infection Risk and Associated Factors in the General Population of a Southern Brazilian State STI & HIV 2023 World Congress 2023."},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1590\/0102-311x00170118"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.1080\/19419899.2020.1773909"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000010573"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100642"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2024.100798"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-27909-7"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30469-9"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2008.12.005"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89102012005000037"},{"key":"e_1_2_12_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-022-00614-0"},{"key":"e_1_2_12_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h6895"},{"key":"e_1_2_12_30_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0016395"}],"container-title":["AIDS Research and Treatment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/arat\/6671976","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/arat\/6671976","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/arat\/6671976","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T09:27:36Z","timestamp":1785058056000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/arat\/6671976"}},"subtitle":[],"editor":[{"given":"Malik","family":"Suliman Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/arat\/6671976"],"URL":"https:\/\/doi.org\/10.1155\/arat\/6671976","archive":["Portico"],"relation":{},"ISSN":["2090-1240","2090-1259"],"issn-type":[{"value":"2090-1240","type":"print"},{"value":"2090-1259","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-08-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"6671976"}}