ABSTRACT
OBJECTIVES: To estimate the number of persons living with HIV (PLWH) in the United States and to describe their care status. METHODS: Estimates of diagnosed PLWH in New York City and other 19 jurisdictions based on HIV case reporting were compared with those based on HIV laboratory reporting. A revised HIV care continuum was constructed based on previously published data. RESULTS: The estimate of PLWH based on HIV case reporting was 25.6% higher than that based on HIV laboratory reporting data in New York City. There were 819,200 PLWH in the United States at the end of 2011 (plausible range: 809,800-828,800), of whom 86% were diagnosed, 72% were retained in care (≥1 care visit in 2011), 68% were on antiretroviral therapy, and 55% were virally suppressed (≤200 copies/mL). CONCLUSIONS: The current method based on HIV case reporting may have overestimated PLWH in the United States. While we continue cleaning HIV case reporting data to improve its quality, we should take the opportunity to use comprehensive HIV laboratory reporting data to estimate PLWH at both the national and local levels.
Subject(s)
Continuity of Patient Care/statistics & numerical data , HIV Infections/epidemiology , Population Surveillance , Adult , CD4 Lymphocyte Count , Centers for Disease Control and Prevention, U.S. , HIV Infections/diagnosis , Humans , Outcome Assessment, Health Care , United States/epidemiology , Viral LoadABSTRACT
BACKGROUND: Antibody cross-reactivity complicates differential diagnosis of human immunodeficiency virus (HIV) type 2 (HIV-2) using standard serologic screening and confirmatory tests for HIV. HIV type 1 (HIV-1) viral load testing does not detect HIV-2. Although HIV-2 is, in general, less pathogenic than HIV-1, it can lead to immunosuppression and clinical AIDS, and there are important differences in the selection of antiretroviral therapy for HIV-2-related immunosuppression that make it imperative to differentiate between the 2 viruses. The New York City Department of Health (New York, NY) seeks to facilitate accurate diagnosis and surveillance of HIV-2 infection in the city. METHODS: We used routine HIV-1-2+O screening and a comprehensive algorithm to differentiate between HIV-1 and HIV-2 infection, universal HIV-related laboratory test reporting, population-based surveillance of HIV infection, and active communication with clinicians. RESULTS: Between 1 June 2000 and 31 December 2008, 62 persons received a diagnosis of confirmed or probable HIV-2 infection. The majority (60 [96.8%] of 62 individuals) were foreign-born (96.7% were born in Africa) and of black race/ethnicity (93.5%). At the time of initial diagnosis, 17.7% of patients with HIV-2 infection had AIDS. Forty (64.5%) of the patients received an initial diagnosis of HIV-1 infection. Among these patients, the median lag between initial diagnosis of HIV-1 infection and identification of HIV-2 as the infecting organism was 487.5 days. CONCLUSION: HIV-2 should be ruled out in persons presenting for HIV testing who originate in or travel to West Africa and other areas in which HIV-2 is endemic, particularly those who have negative or indeterminate results on HIV-1 Western blot testing or have atypical banding patterns and/or present with clinical signs of HIV infection or unexplained immunosuppression.
