Downie JH, et al. - In view of the common occurrence of late diagnosis of HIV (CD4 < 350) in the UK and missed opportunities (MOs) for testing, researchers conducted this multi-center audit reviewing all new, late HIV diagnoses across three centers in North East England. They employed a standardized review process (incorporating a shared regional pathology system and summary care records) to recognize MOs. They reviewed 45 late diagnoses (median age 45 years, 76% male, median CD4 cell count 134); of these, 28 (62%) had one or more MO, with a median of 18 months from MO to the presentation. Sixty-two percent of MOs happened in primary care and most (82%) comprised indicator conditions. Despite challenges in eliciting full medical records, they described the higher efficacy of the comprehensive review process, which incorporates two regional electronic records, vs previous methodologies; more MOs were recognized with the described process. These findings suggest that many people present with late HIV infection or AIDS and there is a necessity for increased efforts to improve testing.