Trends in time from HIV diagnosis to first viral suppression following revised U.S. HIV treatment guidelines, 2012–2017
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Trends in time from HIV diagnosis to first viral suppression following revised U.S. HIV treatment guidelines, 2012–2017

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  • English

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    • Alternative Title:
      J Acquir Immune Defic Syndr
    • Description:

      Since 2012, treatment guidelines have recommended initiating antiretroviral therapy for all persons as soon as possible after HIV diagnosis, irrespective of CD4 counts. If clinicians adopted the treatment guidelines, a shortened interval between diagnosis and first viral suppression (Dx-to-VS) would be expected, with greater declines among those with CD4 counts ≥500 cells/μL at diagnosis.


      Using the National HIV Surveillance System data, we examined Dx-to-VS intervals among persons aged ≥13 years with HIV infection diagnosed during 2012–2017. Analyses were stratified by the first CD4 count: CD4 ≥500 cells/μL, 200–499 cells/μL, <200 cells/μL, and no CD4 value reported within 3 months after diagnosis.


      During 2012–2017 in the 27 US jurisdictions with complete laboratory reporting, 138,759 HIV diagnoses occurred. The median Dx-to-VS interval shortened overall for persons with HIV diagnosed in 2012 vs. 2017 from 9 to 5 months, a 12.3% annual decrease (P < 0.001) and in all CD4 groups. In 2012, the Dx-to-VS interval was longer for persons with CD4 ≥500 cells/μL than 200–499 cells/μL and <200 cells/μL (median, 9, 7, and 6 months, respectively). By 2017, the median interval was 4 months for these groups, compared with 25 months for those without a CD4 value within 3 months after diagnosis.


      Decreases in Dx-to-VS intervals across all CD4 groups with a greater decrease among those with CD4 ≥500 cells/μL are consistent with the implementation of treatment recommendations. The Dx-to-VS interval was longest among persons not linked to care within 3 months after diagnosis, underscoring the importance of addressing barriers to linkage to care for ending the HIV epidemic.

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