Patients who do not have epidemiologic indicators of HIV are more likely to have a history of missed presentation, are less likely to get tested for HIV, and are more likely to neglect HIV symptoms, according to results of a cross-sectional study published in PLoS One.

Joanna Brannstrom, MD, PhD, from the Karolinksa Institute and Karolinska University Hospital in Stockholm, Sweden, and colleagues conducted the national multicenter study to identify risk factors for missed opportunities of diagnosis in HIV-1.

The study included 409 adult patients who were newly diagnosed with HIV-1 during a 2.5-year period. The primary outcomes were missed presentation, defined as a missed HIV diagnosis when a patient presented for care with a clinical indicator for HIV testing, and patient neglect, defined as the presence of HIV or AIDS symptoms experienced by the patient without seeking medical care.

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The results showed that 37% of patients had at least 1 missed opportunity of diagnosis, 27% had a missed presentation, and 16% had neglected HIV/AIDS symptoms.

The odds ratios [ORs] for missed presentations were lower for migrants from East Europe, Asia, and Pacific (East) region (OR: 0.4) compared with individuals who were born in Sweden. The likelihood of a missed presentation was also lower for migrants from sub-Saharan Africa (OR: 0.3) and other migrants (OR: 0.5).

The odds that a patient would have neglected HIV symptoms were also lower among migrants from East Europe, Asia, and Pacific region (OR: 0.3) and migrants from sub-Saharan Africa (OR: 0.4). The odds ratio for neglected symptoms was also lower for men who have sex with men compared with patients who were infected heterosexually (OR: 0.5).

Individuals who were infected with HIV in the East with a history of substance abuse or a prior negative HIV test were more likely to take initiative to test on their own. In contrast, patients over 50 years of age with a previously missed presentation had reduced odds (P<.05).

“The study implies that in the best-case scenario 37% of the patients in our setting could have been diagnosed at an earlier stage as a result of identifications of symptoms alone,” the study authors concluded. “Strategies to identify these patients, without obvious epidemiological indicators of HIV, and other undiagnosed individuals should have the highest priority in the combat against the HIV-1 epidemic.”


  1. Brannstrom J, Svedhem V, Marrone G, et al. Symptomatic patients without epidemiological indicators of HIV have a high risk of missed diagnosis: A multi-centre cross sectional study. PLoS One. 2016; doi: 10.1371/journal.pone.0162503.