NYC Has Stepped Up Timing of HIV Treatment
New Yorkers with HIV infections are getting treated sooner after their diagnosis than in the past, according to a study published in The Journal of Infectious Diseases. The improvement is in keeping with changes in treatment guidelines recommending immediate antiretroviral therapy (ART) for HIV infections regardless of a patient’s white blood cell count.
The study’s co-authors included McKaylee M. Robertson, a research scientist at the Institute for Implementation Science in Population Health at the Graduate School of Public Health & Health Policy; two SPH professors, Sheng Li and Denis Nash; and Sarah Braunstein, director of HIV epidemiology at the city Department of Health and Mental Hygiene.
The researchers examined data for 9,987 New York City residents who were diagnosed with HIV from 2012 through 2015, with follow-up care through June 2017.
In 2012, just 62 percent of patients began ART treatment within six months of diagnosis. By 2015, the percentage of those getting ART within six months of diagnosis was substantially higher at 77 percent. The median time from diagnosis to ART also decreased, from well over three months to just over two months.
The percentage of cases diagnosed at an early stage of infection increased only slightly over the four-year period, from 35 percent to 37 percent.
The statistics represent a “slow trend toward earlier ART initiation but no trend toward earlier diagnosis,” the authors wrote.
“To realize the full individual and population benefits from expanded treatment guidelines, HIV-infected persons need to be diagnosed earlier in the course of infection, underscoring the need for continued efforts to focus HIV testing in population groups with historically low testing frequency and high rates of late HIV diagnosis,” they added. “Moreover, continued improvements in rates of ART initiation after diagnosis are necessary.”
Earlier in the fight to halt AIDS, the initiation of antiretroviral therapy depended on the patient’s CD4 (white blood cell) counts. More recent standards recommend ART after HIV diagnosis regardless of CD4 levels. Antiretroviral treatment increases CD4 counts and decreases HIV levels. Once virus levels are so low they cannot be detected, the patient can no longer transmit the infection. That means widespread testing, early diagnosis, and immediate ART are essential to controlling the epidemic.