End of AIDS in New York State? Insights from HIV Surveillance Data

BACKGROUND:  Momentum around ending the HIV epidemic has increased in recent years.  In the absence of a vaccine or cure, the New York State (NYS) discussion of “End of AIDS” has focused on markedly decreasing new HIV transmissions and decreasing progression to AIDS among those already infected. Key epidemiologic measures derived from HIV surveillance data were used to construct a scenario that could represent the “End of AIDS” in NYS.

METHODS:  The “End of AIDS” indicator selected for this project was the achievement of a transmission rate of less than 0.5 new infections per 100 living infected persons by 2020. New infections in 2011 were estimated using CDC incidence methodology and were projected to decline exponentially to the specified 2020 target.   Deaths among persons living with diagnosed HIV and new HIV diagnoses over the period 2013-2020 were projected linearly using NYS HIV surveillance data from 2007-2011.  Persons living with HIV infection in 2011, both total and diagnosed, were extended through 2020 using the projected new infections, new diagnoses, and deaths. 

RESULTS: The target decline in the HIV transmission rate would reduce new HIV infections in NYS from 3,640 in 2011 (equivalent to a transmission rate of 2.4 per 100 infected persons) to 730 in 2020, a drop of 80%. Over the same period projected deaths decrease from 2,196 to 1,045. Total persons living with HIV infection remain relatively constant at 150,000 over the period, while persons living with diagnosed infection increase by 11,000, from 131,000 to 142,000.   

CONCLUSIONS: Quantitative conceptualization of the “End of AIDS” in NYS necessitates many assumptions and is limited by absence of routine, standardized surveillance methodology for incorporation of HIV-infected persons diagnosed elsewhere who have moved into NYS and by lack of state-specific information on the percent infected but unaware of their HIV diagnosis.  Even so, with the achievement of a significant “End of AIDS” transmission benchmark, we postulate that the number of persons living with diagnosed HIV infection will continue to rise for years, and that the gap between projected deaths and new infections will remain small.  Thus, the decrease in transmissions will not be accompanied by an immediate decrease in the total number of persons living with HIV infection, and the need to devote resources to the care of HIV-infected people will continue for years to come.