Prevalence of undiagnosed HIV infection among persons aged >/=13 years–National HIV Surveillance System, United States, 2005–2008

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, 1600 Clifton Rd, MS E-47, Atlanta, GA 30333, USA.
MMWR. Morbidity and mortality weekly report 06/2012; 61 Suppl(Suppl):57-64.
Source: PubMed


In the United States, approximately 1.1 million adults and adolescents are living with human immunodeficiency virus (HIV) infection and, each year, another 50,000 become infected. At the end of 2008, approximately 20% of the persons living with HIV had an undiagnosed infection. Of those living with HIV at the end of 2008, nearly two thirds were racial/ethnic minorities and half were men who have sex with men (MSM). In 2007, HIV ranked fifth as a leading cause of death among persons aged 35-44 years in the United States but third among blacks or African Americans in this age group. In 40 states with longstanding confidential name-based HIV surveillance systems, 33% of the estimated 41,768 adults and adolescents diagnosed with HIV infection in 2008 developed acquired immunodeficiency syndrome (AIDS) within 1 year and, of these, 44% received their initial diagnosis in an acute care setting, suggesting that they received HIV testing late in the course of the infection. HIV-infected persons who are unaware of their infection or who receive a late diagnosis cannot benefit fully from timely initiation of therapy and are more likely to experience HIV-related morbidity and premature mortality. In addition, persons unaware of their infection are more likely to transmit HIV to others because of a higher prevalence of high-risk sexual behaviors and higher levels of viral RNA that continue to replicate without appropriate antiretroviral treatment.

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    • "The extent to which the provision of and retention in treatment may be as successful as when implemented in prison (more stable environment) is unknown though recent data from Connecticut suggests that prescribing ART soon after jail admission results in high levels of viral suppression[74]. It is important to mention that provision of routine HIV screening upon jail or prison entry and ART coverage varies significantly geographically[35,767778798081; however these settings present the best opportunity to identify undiagnosed infections and to link individuals into care, since for this population, this might be the best opportunity to access proper healthcare services. Going beyond the mathematical modeling domain, the key question is how to translate the potential that HIV-TTR interventions have in halting the HIV epidemic when dealing with hard-to-reach populations, and how to use these interventions to help reduce racial and social inequalities surrounding the HIV epidemic among correctional populations[82,83]. "

    Full-text · Article · May 2015 · PLoS ONE
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    • "Prevention and treatment of Human Immunodeficiency Virus (HIV) infection have evolved through important advances in the field, and the number of new HIV infections in the United States has steadied near 50,000 cases annually [1] [2]. However one-fifth of adults and up to one half of HIV-infected young persons in the United States (US) are not aware of their positive status [3] [4] [5] [6] [7] [8] [9]. "
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    ABSTRACT: The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.
    Full-text · Article · Sep 2013 · AIDS research and treatment
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    ABSTRACT: Objectives To determine the prevalence of cryptococcal antigenemia in a UK HIV cohort and compare baseline characteristics of patients with and without cryptococcal antigenemia. Methods Stored sera were retrospectively tested for cryptococcal antigen (CRAG) among newly diagnosed HIV-infected persons with CD4 < 100 cells/μL, who presented to Croydon University and St George's Hospitals, London, between January 2004 and October 2010. We assessed risk factors for cryptococcal antigenemia and patient outcomes by extracting demographic and clinical information from medical records. Results 157 patients were identified with a median age of 47 and CD4 count of 26 cells/μL. 102 (65%) were of Black race and 91 (58%) of African origin. Eight patients (5%) had positive serum CRAG. 7/8 had cryptococcal meningitis (CM) as first presentation of HIV, and 1 had sub-clinical infection. 7/8 (88%) CRAG positives were of African origin compared to 84/149 (54%) of CRAG negatives (p = 0.14). Other baseline characteristics did not differ significantly. Conclusion We found a 5% prevalence of cryptococcal antigenemia in newly diagnosed HIV patients with CD4 < 100 cells/μL in southwest London, the first such data for a UK HIV cohort. Cryptococcal antigenemia occurred almost exclusively in African-born individuals. We recommend a UK CRAG screening strategy targeting newly diagnosed African HIV-infected patients with CD4 < 100 cells/μL.
    Full-text · Article · Oct 2012 · The Journal of infection
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