BACKGROUND: In 2014, New York State (NYS) announced a three point plan to end the AIDS epidemic. One key point is to identify individuals with undiagnosed HIV infection and link them to medical care. Identifying individuals with a concurrent diagnosis -- initial diagnosis of HIV-infection followed within 30 days by a subsequent AIDS diagnosis (stage 3 HIV) -- is important to identify missed earlier diagnostic opportunities. The aim of this study includes: 1) identifying the concurrently HIV/AIDS diagnosed; and 2) describing the characteristics of the concurrently HIV/AIDS diagnosed.
METHODS: NYS surveillance data were used to identify and describe individuals with a concurrent diagnosis in 2014. Crude and adjusted logistic regression models were used to investigate the relationship between concurrent diagnosis and sex at birth, age, race/ethnicity, and HIV transmission risk group. Models were further stratified by three sex at birth-transmission groups: 1) men who have sex with men (MSM); 2) males without documented MSM risk; and 3) females of any transmission risk.
RESULTS: In 2014, 3,434 NYS residents were diagnosed with HIV infection; 680 (19.8%) were concurrently diagnosed with AIDS. Most new diagnoses were attributed to MSM or MSM/IDU transmission risk (58.5%). Males without documented MSM risk (n=690) and females (n=735) each represented about 20%. Mirroring new diagnoses, the concurrently diagnosed were predominately male (77.8%) and non-Hispanic black or Hispanic (40.7% and 30.0% respectively), though the average age at diagnosis was higher for the concurrent group (42 vs 37 years for all new diagnoses). Compared to the non-concurrent, the proportion MSM was substantially lower, with more males lacking documented MSM risk (MSM 46.3%; male non-MSM 31.5%; females 22.2%). Adjusted logistic regression models with collapsed transmission categories consistently identified increased odds of concurrency in older individuals (>30 years) compared to younger individuals (30-39 adjusted OR[aOR]=2.5: 95% CI 2.0-3.3; 40-49 aOR=3.6: 2.7-4.7; 50-59 aOR=4.6: 3.4-6.1; 60+ aOR=4.4: 3.0-6.5). Multi-racial individuals had an increased odds of concurrent diagnosis (aOR=1.9: 1.2-2.8) compared to non-Hispanic white individuals. Stratified analyses by transmission group yielded similar results.
CONCLUSIONS: Age was the most significant predictor of concurrent diagnosis indicating years of missed opportunities for HIV testing. Testing initiatives should be directed at all age groups, though specific efforts to encourage older populations to test for HIV are needed. Testing throughout the life course should be framed in terms of the opportunity to diagnose HIV infection sooner, before the disease progresses to AIDS and the concomitant poorer outcomes.