McKaylee M Robertson1, Sarah L Braunstein2, Donald R Hoover3, Sheng Li4, Denis Nash1. 1. Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA. 2. Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA. 3. Rutgers University, Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Piscataway, New Jersey, USA. 4. Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA.
Abstract
BACKGROUND: We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. METHODS: Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. RESULTS: Among 28 162 people diagnosed with HIV during 2006-2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132-504) cells/µL to 390 (IQR, 216-571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3-11.4) years in 2006 to 3.7 (IQR, 0.5-8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5-10.5) years to 3.3 (IQR, 0-8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2-2.1) years to 0.2 (IQR, 0.1-0.3) years from 2006 to 2015. CONCLUSIONS: The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.
BACKGROUND: We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. METHODS: Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. RESULTS: Among 28 162 people diagnosed with HIV during 2006-2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132-504) cells/µL to 390 (IQR, 216-571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3-11.4) years in 2006 to 3.7 (IQR, 0.5-8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5-10.5) years to 3.3 (IQR, 0-8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2-2.1) years to 0.2 (IQR, 0.1-0.3) years from 2006 to 2015. CONCLUSIONS: The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.
Authors: Myron S Cohen; Ying Q Chen; Marybeth McCauley; Theresa Gamble; Mina C Hosseinipour; Nagalingeswaran Kumarasamy; James G Hakim; Johnstone Kumwenda; Beatriz Grinsztejn; Jose H S Pilotto; Sheela V Godbole; Sanjay Mehendale; Suwat Chariyalertsak; Breno R Santos; Kenneth H Mayer; Irving F Hoffman; Susan H Eshleman; Estelle Piwowar-Manning; Lei Wang; Joseph Makhema; Lisa A Mills; Guy de Bruyn; Ian Sanne; Joseph Eron; Joel Gallant; Diane Havlir; Susan Swindells; Heather Ribaudo; Vanessa Elharrar; David Burns; Taha E Taha; Karin Nielsen-Saines; David Celentano; Max Essex; Thomas R Fleming Journal: N Engl J Med Date: 2011-07-18 Impact factor: 91.245
Authors: Sara Lodi; Andrew Phillips; Giota Touloumi; Ronald Geskus; Laurence Meyer; Rodolphe Thiébaut; Nikos Pantazis; Julia Del Amo; Anne M Johnson; Abdel Babiker; Kholoud Porter Journal: Clin Infect Dis Date: 2011-10 Impact factor: 9.079
Authors: Qiang Xia; Laura S Kersanske; Ellen W Wiewel; Sarah L Braunstein; Colin W Shepard; Lucia V Torian Journal: J Acquir Immune Defic Syndr Date: 2015-03-01 Impact factor: 3.731