Indicator condition-guided HIV testing in Europe: a step forward to HIV control Francesco Blasi 1 and Alberto Matteelli 2 Affiliations: 1 Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca ` Granda Milan, Milan, and 2 Institute of Infectious and Tropical Diseases, University of Brescia, WHO collaborating centre for TB/HIV collaborative activities, Brescia, Italy. Correspondence: F. Blasi, Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca ` Granda Milan, Italy. E-mail: francesco.blasi@unimi.it @ERSpublications New guidance highlights condition-guided HIV testing http://ow.ly/mEYku A new guidance document was published in November 2012 by ‘‘HIV in Europe’’, a pan-European initiative constituted by an independent group of experts with representation from civil society, policy- makers, health professionals and European public health institutions. This initiative was started in Brussels in 2007 to promote early diagnosis and earlier care of the HIV infection across Europe. The document, ‘‘HIV indicator conditions: guidance for implementing HIV testing in health care settings’’ is an important step to ensure that people living with HIV enter care earlier in the course of their infection [1]. It was developed by a multidisciplinary panel of experts, because the active commitment of several medical specialties was considered an essential prerequisite for the successful implementation of the recommended approach. The European Respiratory Society (ERS) has decided to support the initiative and to operate so that its affiliates are part of the project. The ERS recognised early the importance of the synergistic relationship between tuberculosis and HIV and the European Respiratory Journal is on the frontline of the scientific production in this area as certified by recent pivotal publications [2–5]. Now it is time to go beyond. It is estimated that one in three of the ,2.3 million HIV-infected individuals living in the European region (i.e. 700,000–900,000 individuals) are unaware of their HIV status [6]. These persons will be diagnosed with HIV infection when the disease becomes symptomatic because of profound immunodeficiency (i.e. with a CD4 count below 350 cells?mL -1 ) and will be called ‘‘late presenters’’. Experts believe that a significant proportion of late presenters has been in contact with the healthcare system prior to being diagnosed. Some might have had a sero-conversion illness which remained undiagnosed, others probably presented to one or more health care setting with symptoms caused by diseases associated with immunodeficiency (typically an herpes zoster episode, or oral candidiasis). An HIV infection which is left untreated because it is undiscovered, will develop in most cases into a full blown AIDS within 12–20 years after the primary infection [7]. If the person is, however, diagnosed and highly active anti-retroviral treatment (HAART) is initiated timely, before severe impairment of the immune system has occurred, life-expectancy may approach that of the general population [8]. Hence, wide access to HIV treatment in Europe has resulted in a situation in which HIV-related morbidity and mortality mainly concerns those who are diagnosed late. Increased HIV-related morbidity and mortality [9], poorer response to treatment [10] and increased healthcare costs are the consequences of late HIV diagnosis [11]. Moreover, delayed diagnosis is one the most important determinants of increased rates of HIV transmission; based on US modelling data, half of Received: Nov 06 2012 | Accepted after revision: Dec 20 2012 Conflict of interest: None declared. Copyright ßERS 2013 EDITORIAL HIV | Eur Respir J 2013; 42: 572–575 | DOI: 10.1183/09031936.00179412 572