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PLoS One. 2016 Sep 7;11(9):e0162503. doi: 10.1371/journal.pone.0162503. eCollection 2016.

Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study.

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Unit of Infectious Diseases, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Infectious Diseases, Sundsvall County Hospital, Sundsvall, Sweden.
Department of Infectious Diseases, Gävle County Hospital, Gävle, Sweden.
Department of Clinical Science and Education, Venhälsan, Stockholm South General Hospital, Stockholm, Sweden.
Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.



One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis.


A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient's neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed.


The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2-0.8); Sub-Saharan Africa (SSA): 0.3 (0.2-0.6); other: 0.5 (0.2-1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1-1.0); SSA (0.4 (0.2-0.8)). The latter was also lower for men who have sex with men (0.5 (0.2-1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05.


Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.

[Indexed for MEDLINE]
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Conflict of interest statement

AS has received grants for the study from the Swedish Board of Health and Welfare, Public Health Agency of Sweden and Gilead Science Nordic. JB received grants from Karolinska Institutet and Swedish Physicians against AIDS Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. JB had full access to the data and responsibility for the submission. For the remaining authors none were declared. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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