Background: Late HIV diagnosis is detrimental both to the individual and to society. Strategies to improve early diagnosis of HIV must be a key health care priority. We examined whether nation-wide electronic registry data could be used to predict HIV status using machine learning algorithms.

Methods: We extracted individual level data from Danish registries and used algorithms to predict HIV status. We used various algorithms to train prediction models and validated these models. We calibrated the models to mimic different clinical scenarios and created confusion matrices based on the calibrated models.

Findings: A total 4,384,178 individuals, including 4,350 with incident HIV, were included in the analyses. The full model that included all variables that included demographic variables and information on past medical history had the highest area under the receiver operating characteristics curves of 88·4% (95%CI: 87·5% - 89·4%) in the validation dataset. Performance measures did not differ substantially with regards to which machine learning algorithm was used. When we calibrated the models to a specificity of 99·9% (pre-exposure prophylaxis (PrEP) scenario), we found a positive predictive value (PPV) of 8·3% in the full model. When we calibrated the models to a sensitivity of 90% (screening scenario), 384 individuals would have to be tested to find one undiagnosed person with HIV.

Interpretation: Machine learning algorithms can learn from electronic registry data and help to predict HIV status with a fairly high level of accuracy. Integration of prediction models into clinical software systems may complement existing strategies such as indicator condition-guided HIV testing and prove useful for identifying individuals suitable for PrEP.

Funding: The study was supported by funds from the Preben and Anne Simonsens Foundation, the Novo Nordisk Foundation, Rigshospitalet, Copenhagen University, the Danish AIDS Foundation, the Augustinus Foundation and the Danish Health Foundation.