5% were late presenters for HIV diagnosis. Among 6897 treatment-naïve patients in the ClinSurv cohort, 58.1% were late presenters for care. Late presenters for care were older (median 42 vs. 39 years for early presenters), more often check details heterosexuals from low-prevalence countries (18.1% vs. 15.5%, respectively) and more

often migrants (18.2% vs. 9.7%, respectively; all P < 0.005). The probability of late presentation was >65% throughout the observation period in migrants. The probability of late presentation for care clearly decreased in men who have sex with men (MSM) from 60% in 1999 to 45% in 2010. In Germany, the numbers of late presenters for HIV diagnosis and care remain high. The probability of late presentation for HIV diagnosis seems to be particularly high for migrants. These results argue in favour of targeted test promotion rather than opt-out screening. Late presentation for care seems to be an additional problem after HIV diagnosis. The introduction of antiretroviral therapy (ART) has led to a dramatic decrease in HIV-associated morbidity and mortality [1, 2]. The risk for AIDS-defining events is highest in patients who do not receive antiretroviral treatment or who initiate

ART in advanced stages of immunodeficiency [3, 4]. CD4 T-cell counts see more of <200 cells/μL were long considered the threshold at which to initiate antiretroviral treatment. Although most cases of severe opportunistic diseases occur at CD4 counts of <200 cells/μL, more recent studies have shown an increased risk for AIDS or death even in patients with higher

CD4 T-cell counts [5, 6]. These observations led to the recommendation that therapy should be started at 350 [7] or even 500 cells/μL [8]. The goal of therapy is the prevention of disease progression by starting therapy before CD4 cell counts drop below these thresholds. This can only be achieved if HIV infection is diagnosed early enough. second It is estimated that in Europe, even with general availability of high-quality and affordable health care, as many as 25–35% of individuals who are infected with HIV are unaware of their HIV status. Therefore, late presentation remains a major challenge in patient management. Throughout Europe, factors associated with late presentation include older age, migrant status, heterosexual risk of transmission and male sex [9-15]. However, these factors may change over time and may be different for different regions of Europe. Recently a European consensus definition of late presentation (CD4 count <350 cells/μL or clinical AIDS) and presentation with advanced HIV disease (CD4 count <200 cells/μL or clinical AIDS) was published to facilitate cross-country comparisons of trends and results of targeted interventions [16]. Country-specific risk analyses are important to effectively guide public health interventions. Data concerning the situation of late presentation in Germany and detailed analyses are largely missing.