Delays in HIV Diagnosis Remains a Nationwide Issue, Barrier to Appropriate Care

Improvements are still needed for early identification of HIV, particularly in older individuals, males, and people of Asian descent, according to study findings published in Morbidity and Mortality Weekly Report.¹

Delayed HIV diagnosis continues to be a substantial issue in some populations and prevents early initiation of care, which would improve health outcomes and reduce HIV transmission to other individuals.

The study investigators sought to determine a quantifiable measure of diagnosis delay rather than its potential contributors. Investigators obtained HIV patient data from the Centers for Disease Control and Prevention (CDC)’s National HIV Surveillance System (NHBS) to estimate the time between infection to HIV diagnosis as well as the percentage of patients living with an undetected HIV infection at the end of 2015. In addition, patient data were evaluated to estimate the percentage of patients at risk for HIV who had been tested for the virus within 12 months of the start of the study.

A total of 1,122,900 people were found to be living with HIV infection, of which 14.5% (n=162,500) were estimated to be living with an undiagnosed infection. Individuals in the NHBS were more likely to have been tested for HIV in the past 12 months if they were men who had sex with men (71%) vs individuals who injected drugs (58%) or heterosexual individuals (41%).

In 2015, there was an estimated median HIV diagnosis delay of 3 years (interquartile range, 0.7-7.8 years) in the individuals diagnosed with the virus (n=39,720). Older age was significantly associated with a longer diagnosis delay (median=4.5 years in people age ≥55 vs 2.4 in people age 13 to 24; P <.01). Individuals of Asian descent were also more likely to experience a longer diagnosis delay compared with whites (4.2 vs 2.2 years, respectively; P <.01).

In addition, males had a significantly longer delay in diagnosis than females (3.1 vs 2.4 years, respectively; P <.01). Males also had a relatively long diagnosis delay if the virus was transmitted via heterosexual contact (median=4.9 years).

Patients from the NHBS are not truly representative of all patients with HIV, so it may not be possible to generalize the study findings across all infected individuals.

The investigators noted that “HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.”

References

1. Dailey AF, Hoots BE, Hall HI, et al. Vital signs: Human Immunodeficiency Virus testing and diagnosis delays – United States. MMWR Morb Mortal Wkly Rep. 2017;66:1300-1306.
2. Satcher Johnson A, Song R, Hall HI. Estimated HIV incidence, prevalence, and undiagnosed infections in US states and Washington, DC, 2010–2014.J Acquir Immune Defic Syndr. 2017;76:116-122.