HIV test-and-treat policies in NYC nearly halve time to treatment
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There was a 42% reduction in the median time from HIV seroconversion to ART initiation among people with HIV in New York City over a recent 10-year period, suggesting an increase in the implementation of test-and-treat policies, including the recommendation to “treat all” infected patients immediately, researchers said.
“The elapsed time from infection to diagnosis or treatment initiation matters because this represents time when an individual misses out on the benefits of treatment,” McKaylee M. Robertson, PhD, epidemiologist with the Institute for Implementation Science in Population Health at the City University of New York, said in a news release. “If we can continue to reduce diagnosis and treatment delays, then we may continue to see declines in HIV incidence and mortality.”
Robertson and colleagues analyzed data collected by the New York City Department of Health and Mental Hygiene (DOHMH), which “has conducted population-based, name-based AIDS surveillance since 1981 and HIV surveillance since 2000,” they wrote. The study population included New York City residents who were aged 13 years or older at the time of their HIV diagnosis between 2006 and 2015. The study period encompassed the DOHMH’s recommendation in 2011 to immediately treat all people diagnosed with HIV.
From 2006 to 2015, 28,162 people were diagnosed with HIV, of whom 89% initiated ART by June 2017. The median CD4 count at diagnosis was 326 cells/L in 2006 and 390 cells/L in 2015.
The median time from estimated seroconversion to ART initiation decreased from 6.4 years in 2006 to 3.7 years in 2015, according to Robertson and colleagues — a 42% decline. Furthermore, the time from estimated seroconversion to HIV diagnosis decreased by 28%, from 4.6 years in 2006 to 3.3 years in 2015. Robertson and colleagues also observed a 60% decrease in the median time from HIV diagnosis to ART initiation, from a median of 0.5 years in 2006 to 0.2 years in 2015. The researchers said these two reductions have contributed to the decreases in time to ART initiation.
“Our analysis shows considerable progress in rapid ART initiation following HIV seroconversion in the era of ‘treat all’ recommendations in New York City,” Robertson and colleagues wrote. “However, substantive efforts are needed to reduce the much larger interval from seroconversion to diagnosis.”
The authors further emphasized the importance of early diagnosis.
“Targeted HIV testing strategies are needed to more rapidly identify people with undiagnosed HIV soon after HIV seroconversion in order to achieve further reductions in HIV incidence and mortality in key subgroups who continue to be negatively impacted by the HIV epidemic.,” they wrote. – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Elizabeth Connick, MD
From a public health perspective, this is good news because it means that efforts to diagnose HIV infections earlier and to initiate ART have been at least partially successful. From an individual point of view, this is also good news because earlier initiation of ART means that HIV-seropositive individuals have relatively more intact immune systems compared with those of the past, which bodes well for both their short-term and long-term health. Nevertheless, it is disappointing to see that disparities in timing of diagnoses and ART initiation persist, even in a city that is highly motivated to diagnose and treat HIV, with women, blacks, heterosexuals and older individuals experiencing greater delays in diagnosis and initiation of ART compared with others. It is critical that more effective measures be undertaken to improve diagnoses and early ART initiation in all individuals at risk for HIV.
Professor of medicine
Chief, division of infectious diseases
University of Arizona College of Medicine – Tucson
Member, Women’s Research Initiative on HIV/AIDS
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