{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T19:21:49Z","timestamp":1776540109932,"version":"3.51.2"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gilead Fellowship Program","award":["2019\/ST\/016"],"award-info":[{"award-number":["2019\/ST\/016"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Late diagnosis is still a major issue in HIV infection management, leading to important consequences for both patients and community. In this perspective, HIV screening targeted on some clinical conditions (HIV indicator conditions\u2014HIVICs) emerged as a useful strategy, also involving patients not considered at high behavioral risk. We organized an in-hospital HIVICs guided screening campaign named ICEBERG in Milan, Italy, between 2019 and 2021. Among the 520 subjects enrolled, mainly presenting with viral hepatitis or mononucleosis-like syndrome, 20 resulted HIV positive (3.8% prevalence). A significant proportion of them had multiple conditions and advanced immunosuppression, with 40% being AIDS-presenters. As adherence to the screening campaign was modest for non-ID specialists, educational interventions to raise clinicians\u2019 sensitivity are urgently needed. HIV-ICs guided testing was confirmed as a useful tool, but a combined approach with other screening strategies seems to be essential for early HIV diagnosis.<\/jats:p>","DOI":"10.3390\/life13041014","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T02:03:38Z","timestamp":1681437818000},"page":"1014","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["HIV-Indicator Condition Guided Testing in a Hospital Setting"],"prefix":"10.3390","volume":"13","author":[{"given":"Diletta","family":"Barbanotti","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3083-2962","authenticated-orcid":false,"given":"Camilla","family":"Tincati","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5899-451X","authenticated-orcid":false,"given":"Alessandro","family":"Tavelli","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Santoro","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Sala","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Bini","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"De Bona","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-1789","authenticated-orcid":false,"given":"Antonella","family":"d\u2019Arminio Monforte","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia Carla","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,14]]},"reference":[{"key":"ref_1","unstructured":"UNAIDS (2021, November 05). 90-90-90: An Ambitious Treatment Target to Help End the AIDS Epidemic. Available online: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/90-90-90_en.pdf."},{"key":"ref_2","unstructured":"UNAIDS (2021, November 05). 90\u201390\u201390: Good Progress, But the World Is Off-Track for Hitting the 2020 Targets. Available online: https:\/\/www.unaids.org\/en\/resources\/presscentre\/featurestories\/2020\/september\/20200921_90-90-90."},{"key":"ref_3","unstructured":"European Centre for Disease Prevention and Control (2020). HIV\/AIDS Surveillance in Europe, European Centre for Disease Prevention and Control."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1136\/sextrans-2015-052073","article-title":"HIV indicator condition-guided testing to reduce the number of undiagnosed patients and prevent late presentation in a high-prevalence area: A case\u2013control study in primary care","volume":"91","author":"Joore","year":"2015","journal-title":"Sex Transm. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1468-1293.2004.00193.x","article-title":"The high cost of medical care for patients who present late (CD4<200 cells\/\u03bcL) with HIV infection","volume":"5","author":"Krentz","year":"2004","journal-title":"HIV Med."},{"key":"ref_6","first-page":"795","article-title":"How achievable is immediate ART for all?","volume":"2","author":"Lundgren","year":"2015","journal-title":"Lancet HIV"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/01.qai.0000151079.33935.79","article-title":"Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs","volume":"39","author":"Marks","year":"2005","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_8","first-page":"1","article-title":"Networks the EHS and DDM. Reduction in undiagnosed HIV infection in the European Union\/European Economic Area, 2012 to 2016","volume":"22","author":"Pharris","year":"2017","journal-title":"Eurosurveillance"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1468-1293.2008.00592.x","article-title":"Indicator disease-guided testing for HIV\u2013The next step for Europe?","volume":"9","author":"Gazzard","year":"2008","journal-title":"HIV Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sullivan, A.K., Raben, D., Reekie, J., Rayment, M., Mocroft, A., Esser, S., Leon, A., Begovac, J., Brinkman, K., and Zangerle, R. (2013). Feasibility and Effectiveness of Indicator Condition-Guided Testing for HIV: Results from HIDES I (HIV Indicator Diseases across Europe Study). PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0052845"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Raben, D., Sullivan, A.K., Mocroft, A., Kutsyna, G., Had\u017eiosmanovi\u0107, V., Vassilenko, A., Chkhartisvili, N., Mitsura, V., Pedersen, C., and Anderson, J. (2019). Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II study\u20132012\u20132015. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220108"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1056\/NEJMsa042657","article-title":"Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral Therapy","volume":"352","author":"Sanders","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_13","unstructured":"European Centre for Disease Prevention and Control (2010). HIV Testing: Increasing Uptake and Effectiveness in the European Uniou, European Centre for Disease Prevention and Control."},{"key":"ref_14","unstructured":"(2021, November 14). HIV in Europe Initiative. HIV Indicator Conditions: Guidance for Implementing HIV Testing Inadults in Health Care Settings. Available online: http:\/\/www.hiveu-rope.eu\/Portals\/0\/Documents\/Guidance.pdf.pdf?ver=2014-01-29-113626-000."},{"key":"ref_15","unstructured":"Centers for Disease Control and Prevention (2021, November 07). Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, Available online: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr5514a1.htm."},{"key":"ref_16","unstructured":"Ministero Della Salute\u2014Commissione Nazionale AIDS (2021, November 17). Documento di Consenso Sulle Politiche di Offerta e le Modalit\u00e0 di Esecuzione del Test per HIV in Italia, Available online: https:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_1647_allegato.pdf."},{"key":"ref_17","unstructured":"NICE (2021, November 17). HIV Testing: Increasing Uptake among People Who May Have Undiagnosed HIV. Available online: https:\/\/www.nice.org.uk\/guidance\/ng60\/chapter\/Recommendations."},{"key":"ref_18","unstructured":"Istituto Superiore di Sanit\u00e0 (2022, June 19). Aggiornamento Delle Nuove Diagnosi di Infezione da HIV e dei Casi di AIDS in Italia. Available online: https:\/\/www.epicentro.iss.it\/aids\/epidemiologia-italia."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/09540121.2019.1619663","article-title":"An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection: Insights from a blinded serosurvey","volume":"32","author":"Felsen","year":"2020","journal-title":"AIDS Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1089\/apc.2013.0013","article-title":"Is self-perceived HIV risk congruent with reported HIV risk among traditionally lower HIV risk and prevalence adult emergency department patients? Implications for HIV testing","volume":"27","author":"Pringle","year":"2013","journal-title":"AIDS Patient Care STDS"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1136\/sextrans-2013-051312","article-title":"Low levels of HIV test coverage in clinical settings in the UK: A systematic review of adherence to 2008 guidelines","volume":"90","author":"Elmahdi","year":"2014","journal-title":"Sex. Transm. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e39530","DOI":"10.1371\/journal.pone.0039530","article-title":"HIV testing in non-traditional settings--the HINTS study: A multi-centre observational study of feasibility and acceptability","volume":"7","author":"Rayment","year":"2012","journal-title":"PLoS ONE"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1001\/archinternmed.2011.535","article-title":"Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments","volume":"172","author":"Kierzek","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref_24","unstructured":"European Center for Disease Prevention and Control (2018). Public Health Guidance on HIV, Hepatitis B and C Testing in the EU\/EEA\u2013An Integrated Approach, European Centre for Disease Prevention and Control (ECDC)."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"94","DOI":"10.3390\/idr15010010","article-title":"HIV Infection Indicator Disease-Based Active Case Finding in a University Hospital: Results from the SHOT Project","volume":"15","author":"Colpani","year":"2023","journal-title":"Infect. Dis. Rep."},{"key":"ref_26","unstructured":"Global HIV Prevention Coalition (2021, November 20). Preventing HIV Infections at the Time of a New Pandemic A Synthesis Report on Programme Disruptions and Adaptations during the COVID-19 Pandemic in 2020. Available online: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/Status%20of%20HIV%20Prevention%20Services%20in%20the%20Time%20of%20COVID-19_web.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"ofab283","DOI":"10.1093\/ofid\/ofab283","article-title":"The Impact of COVID-19 on UNAIDS 90\u201390\u201390 Targets: Calls for New HIV Care Models","volume":"8","author":"Guaraldi","year":"2021","journal-title":"Open Forum. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1001\/archinternmed.2011.538","article-title":"The impact of nontargeted HIV screening in emergency departments and the ongoing need for targeted strategies","volume":"172","author":"Haukoos","year":"2012","journal-title":"Arch Intern Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bogers, S.J., Hulstein, S.H., van der Loeff, M.S., de Bree, G.J., Reiss, P., van Bergen, J.E., and Geerlings, S.E. (2021). Current evidence on the adoption of indicator condition guided testing for HIV in western countries: A systematic review and meta-analysis. EClinicalMedicine, 35.","DOI":"10.1016\/j.eclinm.2021.100877"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Raben, D., and Sullivan, A. (2021). Implementation of indicator condition guided HIV testing still lagging behind the evidence. EClinicalMedicine, 36.","DOI":"10.1016\/j.eclinm.2021.100918"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/hiv.12430","article-title":"Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions","volume":"18","author":"Lord","year":"2017","journal-title":"HIV Med."},{"key":"ref_32","first-page":"e26009","article-title":"HIV testing training for non-HIV specialists in a tertiary hospital: Change in attitudes and rates of HIV screening, P120, HIV Glasgow, 23\u201326 October 2022, Glasgow, UK\/Virtual","volume":"25","author":"Cano","year":"2022","journal-title":"J. Int. AIDS Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/S2352-3018(21)00276-9","article-title":"Implied consent for HIV testing in the UK: Time for a new approach?","volume":"9","author":"Chadwick","year":"2022","journal-title":"Lancet HIV"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/1014\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:15:38Z","timestamp":1760123738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/1014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,14]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["life13041014"],"URL":"https:\/\/doi.org\/10.3390\/life13041014","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,14]]}}}