Primarily this may reflect a declining number of immigrants from high-prevalence regions entering Germany over time. This would have the effect that HIV is increasingly diagnosed in the prevalent pool of ageing migrants in later

stages of HIV infection. Given the high probability of late presentation and a trend towards later presentation in this group, there is clearly a need to identify and lower individual, cultural, and language- and community-related, as well as structural barriers to disease-related knowledge, awareness, and diagnosis in migrant populations in Germany. In the group of patients with IDU, a clear trend towards later presentation was noted. Given the declining number of new diagnoses, this could again reflect increasing diagnosis in an ageing pool of patients. In MSM, Neratinib cell line the probability Ixazomib ic50 of late presentation for diagnosis marginally decreased from approximately 45% to just above 40% in 2010. Absolute numbers of reported HIV diagnoses doubled from 2001 to 2010. At the same time, new diagnoses among MSM tripled

and the proportion of younger MSM below the age of 35 years remained high at approximately 50%. This is in agreement with the assumption of a coincidental increase of HIV infection incidence and uptake of HIV testing in MSM in the period 2001 to 2005. This would explain the declining proportion of late presentation for diagnosis until 2005, because the early-diagnosed fraction of the increased number of incident infections would be preferentially reported. With infection incidence levelling off after 2005, an increasing proportion of newly diagnosed infections in recent years would thus represent infections acquired during the previous period of increasing incidence, leading again to a slight RVX-208 increase in late presentation for diagnosis. Living in smaller cities or rural areas was associated with a higher probability of late HIV diagnosis, although the impact differed among transmission risk groups. Female sex was associated with lower probabilities in heterosexuals and migrants. This has been noted in other European countries and is

thought to be a result of effective antenatal testing [21]. Our results are consistent with those of several studies from other countries such as Italy, France, Spain, Switzerland and the USA, which identified older age and migration status to be among the most important risk factors for late HIV diagnosis. However, many of these studies found other risk factors such as hepatitis coinfection and non-Caucasian ethnicity, probably reflecting epidemiological differences in these countries [4, 9-12, 23-26]. This study also investigated risk factors and trends for late presentation for care in the multi-institutional ClinSurv cohort. In Germany, monitoring of HIV disease is not confined to specialized treatment centres such as those participating in the cohort study.