Only two thirds of people newly diagnosed with HIV in 2008 in 13 areas in the United States established care for their infection within 12 months.1 And only 45% of persons living with HIV in 2009 were in care. Blacks and Hispanics established and stayed in care less often than whites, and heterosexual males established and stayed in care less often than heterosexual females.
Once a person tests positive for HIV, it is critical to begin regular care as soon as possible. And once a person enters care, it is very important to keep all scheduled appointments. HIV-positive people who delay starting care or miss HIV care visits tend to start antiretroviral therapy later and to reach an undetectable viral load less often. They are more likely to pass their HIV to another person, and they are more likely to die.
U.S. experts on HIV infection recommend that HIV-positive people have a CD4 count and viral load test every 3 to 4 months.2 When people with HIV start antiretroviral therapy and reach an undetectable viral load, U.S. experts believe they should get their CD4 count measured every 6 to 12 months. But a recent analysis combining several studies found that only 54% of people who tested positive for HIV in the United States had at least two HIV care visits within a year.3
To determine recent rates of entering care and staying in care among HIV-positive people, the Centers for Disease Control and Prevention (CDC) conducted this new study.1
The study involved people older than 12 who tested positive for HIV by the end of 2008 and were living with HIV at the end of 2009. At the time of their HIV diagnosis, all these people lived in one of 13 areas across the United States -- Delaware, Indiana, Iowa, Kentucky, Missouri, Nebraska, New York State (excluding New York City), North Dakota, San Francisco, South Carolina, Washington, DC, West Virginia, or Wyoming.
The CDC researchers counted the number of HIVpositive people who had (1) at least one CD4 count or viral load test in the past year and (2) two or more CD4 counts or viral load tests at least 3 months apart. The researchers defined an HIV care visit as a visit in which the CD4 count or viral load was measured. Among people diagnosed with HIV in 2008, the CDC team defined establishing HIV care as having a least two CD4 counts or viral load tests (at least 3 months apart) within 12 months of testing HIV-positive.
The CDC team also figured the percent of people who reached a viral load below 400 copies and the percent who reached a CD4 count above 350.
The study involved 100,375 people diagnosed with HIV through the end of 2008 and living at the end of 2009. This number represents about 12% of all HIV-positive people in the United States. Among these 100,375 people, only 58,772 (59%) had at least one HIV care visit in 2009, and only 44,920 (45%) had at least two HIV care visits at least 3 months apart.
A higher proportion of white people had at least one HIV care visit in 2009 (64%) than did black people (55%) or Hispanics (49%). Whites also had a higher proportion of people with 2 or more HIV care visits in 2009 (50%) than did blacks (41%) or Hispanics (40%). A higher proportion of people between 13 and 24 years old had at least one HIV care visit in 2009 (62%) than did 25-to-44-year-olds (59%), 45-to-64-year-olds (58%), or people 65 or older (51%).
The CDC researchers also determined percentages of people who had HIV care visits according to HIV transmission category (how they got infected with HIV). Women who got HIV infection during sex with men had the highest proportion making at least one HIV care visit in 2009 and the highest proportion who had two or more care visits in 2009 (Figure 1). After women infected with HIV during sex, gay or bisexual men who injected drugs had the highest proportion making at least one HIV care visit, followed by gay or bisexual men who did not inject drugs, men infected during sex with women, women who injected drugs, and men who injected drugs.
Figure 1. Proportions of people in six HIV transmission risk groups who were living with HIV at the end of 2009 and made 1 or more HIV care visits (dark cones) or 2 or more HIV care visits (light cones) in 2009. Women are women and girls infected during sex with men or boys; Gay IDUs are gay or bisexual men who also inject drugs. Gay not IDU are gay or bisexual men who do not inject drugs. Nongay men are men or boys infected with HIV during sex with women or girls. Women IDU are women who inject drugs. Nongay men IDU are nongay men who inject drugs.
Among people who tested HIV-positive in 2008, 64% established HIV care (had 2 or more visits within 12 months of testing positive). The percentage was higher for whites (75%) than for Hispanics (69%) or blacks (54%). In the four age groups studied, the percentage that established care within 12 months of testing positive was highest for 25-to-44-year olds (66%), followed by 45-to-64-year-olds (64%), 13-to-24-year-olds (56%), and people 65 or older (56%).
Among people diagnosed with HIV in 2008, women infected during sex with men were the most likely to establish HIV care within 12 months (Figure 2), followed by gay/bisexual men who injected drugs, gay/bisexual men who did not inject drugs, men infected during sex with women, women who injected drugs, and men who injected drugs.
Figure 2. Women and girls infected with HIV sexually and gay and bisexual men started HIV care within 12 months of their positive HIV test more often than heterosexual men or boys infected sexually or male or female injection drug users (IDUs).
Among 5136 people who tested positive for HIV in 2008 and were alive 12 months after testing positive, 80% had a viral load test within those 12 months. In this group, only 42% had a viral load at or below 400 copies within 12 months of their HIV test.
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