Trends in Time From HIV Diagnosis to First Viral Suppression Following Revised US HIV Treatment Guidelines, 2012-2017

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.