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HIV Testing & Impact of Delayed Diagnosis

MMWR; 2017 Dec 1; Dailey, Hoots, et al

For some population groups, delayed human immunodeficiency virus (HIV) diagnoses continues to be substantial and a factor in preventing early entry to care to improve health outcomes and reduce HIV transmission to others. This according to a study that used CDC National HIV Surveillance System data to estimate, among persons with HIV infection diagnosed in 2015, the median interval and range from infection to diagnosis (diagnosis delay). Data from CDC’s National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing. Among the findings:

  • An estimated 15% of persons living with HIV in 2015 were unaware of their infection.
  • Among persons with HIV infection diagnosed in 2015, the estimated median interval from infection to diagnosis was 3 years.
  • Diagnosis delay varied by race/ethnicity and transmission category.
  • 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months.
  • In each risk group, at least two-thirds of persons who did not have an HIV test had seen a healthcare provider in the past year.

Citation:

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. doi:10.15585/mmwr.mm6647e1.

Commentary:

The one positive aspect of this report from the CDC is that the median time from HIV infection to diagnosis continues to decline with time, improving from 3 years, 7 months in 2011, to 3 years in 2015. However, 15% of persons remain unware of their HIV status and accounted for 40% of 39,270 new infections diagnosed in 2015. Preliminary data for 2016 notes the number of new infections to be almost the same at 39,780. These trends continue to call for more consistent HIV screening on the part of providers. The data also exhibits the sustained misconception of HIV risk on the part of patients and clinicians. Since 2006 the CDC has recommended that all persons aged 13 to 64 years be tested at least once in their lifetime. Those from high-risk groups (MSM, injection drug users, and partners of HIV-infected persons) should be tested at least yearly. It may be prudent to test sexually active gay and bisexual men every 3 to 6 months. Until we can identify a greater number of persons who are HIV-infected and unaware, we are unlikely to reach the goals of the National HIV/AIDS set in 2015. These include decreasing to 10% the number of people living with HIV unaware of their serostatus and to reduce the number of new HIV diagnoses by at least 25% by the year 2020. —Jeffrey T. Kirchner, DO, FAAFP, AAHIVS

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