AEGiS-15IAC: Factors associated with late testing for HIV and progression to AIDS in the antiretroviral therapy (ART) era.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Factors associated with late testing for HIV and progression to AIDS in the antiretroviral therapy (ART) era.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1161)

Kellerman SE, Blair J
CDC, Atlanta, GA, United States

Introduction: ART has decreased AIDS incidence in the US, but some people with HIV still progress to AIDS. We determined factors associated with progression to AIDS.

METHODS: Medical record abstraction for the 12 months preceding AIDS diagnosis was performed for persons >13 years old diagnosed with AIDS in 1999 and reported to the HIV/AIDS reporting system in 2000 in Los Angeles and San Francisco, CA; Hartford, CT; Chicago, IL and Boston, MA. A logistic regression model, controlling for age, race, sex, risk, and site evaluated factors associated with late testing (testing HIV positive within 6 months of an AIDS diagnosis).

RESULTS: Of 2037 persons diagnosed with AIDS, 1175 (58%) were late testers: 55% were<40 years old; 82% were male; 32% were Hispanic, 32% White, and 27% Black; and 46% were men who have sex with men (MSM). Of the 831 (42%) who weren't late testers, 39% had no documented insurance coverage in the previous year; 36% had received ART in the previous year, 51% of whom were non-compliant with ART regimens; 10% were homeless; and 3% had evidence of ART resistance. In a logistic regression model, age was not associated with late testing but male heterosexuals (2.1 [1.1, 4.0]) were most likely, while MSM/injection drug users (IDU) (0.6 [0.4, 0.8]), and female IDUs (0.6 [0.4, 0.9]) were less likely, to be late testers, compared to MSM. Hispanics (1.6 [1.3, 2.0]) and Blacks (1.3 [1.0, 1.7]) were more likely to be late testers compared to whites.

CONCLUSIONS: Over half of new AIDS diagnoses were late testers, despite ART availability. Of the remainder, only a third received ART, suggesting that most persons progressing to AIDS are not seeking, or represent missed opportunities for HIV testing; are not seeking or accepting care once they are diagnosed with HIV; or have no access to care. Prevention programs should emphasize early HIV testing, include strategies for linkage to care, and identify HIV positive persons at highest risk of progressing to AIDS.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Incidence, Antiretroviral Therapy, Highly Active, Hispanic Americans, San Francisco, Boston, Chicago, Los Angeles, Humans, Male, Female, therapy, drug therapy

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