HIV is not being diagnosed early enough in New York

The CD4 cell count among persons with newly diagnosed HIV infection is a measure of immune deficiency and the median CD4 count among newly diagnosed persons is an important population-level indicator of the timeliness of HIV diagnosis following infection. Using HIV Surveillance Registry data, New York State monitors trends in the median CD4 count among persons with newly diagnosed HIV. The graph below shows a steady increase in the median CD4 count among persons with newly diagnosed HIV in New York who had a CD4 count within 3 months of their diagnosis, from 315 cells/mm3 in 2006 to 378 cells/mm3 in 2013.

NYS Median CD4

(Link to this graph on the dashboard here)

The median CD4 count among these newly diagnosed persons increased at an average rate of about 9 cells/mm3 per year during 2006-2013. However, it is concerning that the trend appears to have plateaued in recent years and that in 2013 the median CD4 count was only 378 cells per mm3. Importantly, the recent START trial showed that initiating ART before the CD4 count drops below 500 cells/mm3 (versus waiting until the CD4 count dropped below 350 cells/mm3) resulted in major reductions in the risk of serious AIDS events, serious non-AIDS events, and death.1 Even if the rate of increase in the median CD4 count at diagnosis of 9 cells/mm3 each year continued in New York, it would be about 13 years (2028) before it reaches 500 cells/ mm3, when only half of newly diagnosed persons would be in a position to initiate ART at the threshold of that was shown to be more protective in the START trial.

The increase in the median CD4 count at diagnosis in New York since 2006 is likely due (at least in part) to the impact of expanded testing and linkage efforts on earlier diagnosis. This explanation is supported by findings from a recent study from New York City showing that expanded HIV testing coverage was associated with a population-level reduction in the rate of concurrent HIV/AIDS diagnoses among men.2 Together, these findings underscore the need for continued expansion and targeting of HIV testing to promote even earlier HIV diagnosis, care linkage and ART initiation in New York.

 

1.     INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. New England Journal of Medicine 2015; 373:795-807.

2.    Ransome Y, Terzian A, Addison D, et al. Expanded HIV testing coverage is associated with decreases in late HIV diagnoses. AIDS 2015;29:1369-78.