Estimated time from HIV infection to diagnosis and diagnosis to first viral suppression during 2014–2018

Abstract

OBJECTIVE: To examine changes in the lengths of time from HIV infection to diagnosis (Infx-to-Dx) and from diagnosis to first viral suppression (Dx-to-VS), two periods during which HIV can be transmitted. DESIGN: Data from the National HIV Surveillance System (NHSS) for persons who were aged at least 13 years at the time of HIV diagnosis during 2014-2018 and resided in one of 33 United States jurisdictions with complete laboratory reporting. METHODS: The date of HIV infection was estimated based on a CD4+-depletion model. Date of HIV diagnosis, and dates and results of first CD4+ test and first viral suppression (<200 copies/ml) after diagnosis were reported to NHSS through December 2019. Trends for Infx-to-Dx and Dx-to-VS intervals were examined using estimated annual percentage change. RESULTS: During 2014-2018, among persons aged at least 13 years, 133 413 HIV diagnoses occurred. The median length of infx-to-Dx interval shortened from 43 months (2014) to 40 months (2018), a 1.5% annual decrease (7% relative change over the 5-year period). The median length of Dx-to-VS interval shortened from 7 months (2014) to 4 months (2018), an 11.4% annual decrease (42.9% relative change over the 5-year period). Infx-to-Dx intervals shortened in only some subgroups, whereas Dx-to-VS intervals shortened in all groups by sex, transmission category, race/ethnicity, age, and CD4+ count at diagnosis. CONCLUSION: The shortened Infx-to-Dx and Dx-to-VS intervals suggest progress in promoting HIV testing and earlier treatment; however, diagnosis delays continue to be substantial. Further shortening both intervals and eliminating disparities are needed to achieve Ending the HIV Epidemic goals.

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