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Undiagnosed HIV infection is a major challenge in the quest to achieve an AIDS-free world. Undetected HIV and late diagnosis are associated with ill health, increased risk of death from HIV/AIDS and onward viral transmission, constituting a substantial burden to public health budgets worldwide. Roughly half of the 2.2 million people with HIV in Europe are undiagnosed.1 These figures are mirrored in the UK and the USA, where almost one-quarter of >100 000 and one-sixth of 1.1 million people with HIV remain undiagnosed, respectively.2 ,3 Unacceptably high proportions (up to 53%) of patients are diagnosed late (CD4 cell count <350 cells/μL).1 Expansion of HIV testing is therefore key to improving HIV outcomes.
Early diagnosis followed by immediate antiretroviral treatment reduces HIV-related illness and death. Recent data from both the Strategic Timing of AntiRetroviral Treatment and TEMPRANO ANRS 12136 trials have unambiguously shown that these benefits also extend to patients diagnosed at CD4 of ≥500/μL.4 ,5 Timely diagnosis and treatment have additionally been shown to reduce onward transmission at both individual and population levels, indicating that treatment and prevention are inextricably linked,6 and routine HIV testing is considered cost-effective even when combining one-time HIV screening for the whole population with more frequent testing in subpopulations at risk.7
Given these facts, why …