Early diagnosis of HIV is essential for successful treatment and controlling HIV spread in a population. We examined the frequency and characteristics of adults diagnosed late with HIV in New Zealand from 2011–2020.

Routine surveillance data were analysed. Those previously diagnosed overseas or as part of immigration screening, or with missing CD4 count were excluded. ‘Late presentation’ was defined as a CD4 count <350 cells/μL or an AIDS-defining event. ‘Advanced HIV disease’ were those with a CD4 count <200 cells/μL or an AIDS-defining event. Relative risks were calculated using Poisson regression.

Of 1145 people, 40.5% presented late; 24.9% had advanced HIV disease. Of the 464 late diagnoses, 65.5% occurred among men-who-have-sex-with-men (MSM), 26.1% among heterosexuals, 8.4% among others. Heterosexual men and women were more likely to present late (55.3%) compared to MSM (35.6%). Amongst MSM, those who were older, of an ethnicity other than European, acquired HIV overseas, tested because symptomatic, or had their last negative test >2 years prior were more likely to present late and have advanced disease. Amongst heterosexuals, older age, tested because symptomatic, and Pacific ethnicity were associated with late presentation, and Māori, Pacific and Asian people were more likely to have advanced disease.

There continues to be a high proportion of people diagnosed late with HIV. Identifying barriers for testing, missed opportunities for screenings and other factors that delay HIV diagnosis could help develop effective strategies to reduce this burden of late presentation – particularly among heterosexual individuals, non-Europeans, and older people.