Late diagnosis of paediatric HIV infection in high-income countries: Lessons from the HIV Perinatal Virtual Clinic.

INTRODUCTION

Timely diagnosis of HIV in children remains a challenge in all settings including low-prevalence, high-income countries (HIC). We aimed to characterize the prevalence of late diagnosis, and prior missed diagnostic opportunities among new presentations of paediatric HIV in HIC referred to an international Perinatal Virtual Clinic (PVC).

METHODS

Retrospective analysis of new paediatric diagnoses in HIC, referred to the PVC between January 2018 and April 2025. Data on demographics, clinical features and HIV virology/immunology were extracted from standardized referral templates. Cases were categorized as late or non-late diagnosis by age-related CD4 thresholds, and the two groups compared.

RESULTS

Among 45 new paediatric HIV diagnoses referred to the PVC from the European region (41), Australia (2) and Chile (2), the median age was 9 years (IQR 0.8-13); 66% (27/41) were migrants, predominantly from sub-Saharan Africa; 39% (16/41) were born in HIC. Most (27/45;60%) were tested due to symptoms; 21/45 (47%) were diagnosed with AIDS. The median CD4 count was 230 cells/mm3 (IQR 24.5-531), viral load (VL) 316 000 copies/mL (IQR 65 150-1 315  000) with 31/45 (69%) meeting criteria for late diagnosis. Late-diagnosed children had significantly higher VL (p = 0.02) and were more likely to have prior symptomatic healthcare encounters (p = 0.004).

CONCLUSIONS

Despite access to prevention and screening, late paediatric HIV diagnosis persists in HIC, with severe immunosuppression and missed opportunities for earlier recognition and treatment initiation. Improved implementation of family-based screening, particularly following parental/sibling diagnosis or migration from endemic areas, and education of healthcare providers regarding HIV indicator diseases in children are essential.