5 (95% CI 1.2–5.0), respectively. The high proportion of people presenting late reflects inadequate levels of HIV testing. The lower proportion of late presentations among MSM compared with those heterosexually infected may be explained by a higher proportion of recent locally acquired infections together with different testing patterns. There is overwhelming evidence selleckchem that the early diagnosis of HIV infection is important both for the individual and for controlling spread

in a population. With early diagnosis and treatment, outcome is improved, and the risk of transmission can be reduced by reducing individuals’ infectivity through antiretroviral therapy (ART) and by behaviour change [1-3]. Although there is variation in the clinical course of HIV infection, an indication of late diagnosis is given by the presence of clinical or laboratory evidence of immunosuppression at diagnosis. Such parameters have been used to compare late

diagnosis between groups and over time [4]. Most of the published reports have used information on whether the person met criteria for AIDS at the time Selleck Staurosporine of HIV diagnosis, or on the basis of an initial CD4 cell count of <200 cells/μL. However, while previously a CD4 cell count of that level was considered the minimum threshold for ART (with the decision individualized for those with higher counts), there is now general agreement that the minimum should be 350 cells/μL [5-7]. In line with this, a consensus has recently been reached among European countries on two definitions reflecting delayed presentation for care. ‘Late presentation’ refers to entering care with a CD4 count <350 cells/μL or an AIDS-defining event, regardless of the CD4 count. Presentation with ‘advanced HIV disease’ is a subset having a CD4 count <200 cells/μL

and also includes all who have an AIDS-defining Sodium butyrate event regardless of CD4 count [8]. In New Zealand, the early epidemic of AIDS and HIV infection was highly concentrated among men who have sex with men (MSM) [9]. Over time the proportion of people diagnosed with AIDS and HIV infection who were heterosexually infected increased. However, while most infections among MSM were acquired in New Zealand, the majority of those heterosexually infected acquired their infection overseas, and were predominately people from countries where heterosexual transmisson of HIV is common. Between 2000 and 2005 there was a marked rise in the annual number of HIV diagnoses among both groups. Since 2005, the number of MSM diagnosed annually has remained higher than in the 1990s but relatively stable and the number heterosexually infected has dropped as a result of a reduction in those infected outside the country. The most recent national anonymized sentinel surveys among sexual health clinic attenders (in 2005/2006) found a prevalence of 4.4% among MSM, 0.1% among heterosexual men and women, and 0.3% among those injecting drugs but not reporting any current or past homosexual activity [10].