Characteristics and Care Outcomes Among Persons Living With Perinatally Acquired HIV Infection in the United States, 2015

Kristen Mahle Gray, MPH; Xiao Wang, MPH; Jianmin Li, DPE; Steven R. Nesheim, MD

Disclosures

J Acquir Immune Defic Syndr. 2019;82(1):17-23. 

In This Article

Methods

Data from the NHSS reported to CDC through December 2017 were used to determine the number and percentage of persons living with diagnosed PHIV at year-end 2015 by selected demographic characteristics in the United States and 6 dependent areas. Data reflect persons of all ages with PHIV, diagnosed through 2015 and alive at year-end 2015. Data are based on address of residence as of December 31, 2015 (ie, most recent known address). A minimum of 18 months delay was allowed for the reporting of deaths to NHSS.

NHSS data were also used to analyze receipt of HIV care, retention in HIV care, and viral suppression, in 2015 among persons with PHIV, diagnosed by year-end 2014 and alive at year-end 2015, by selected characteristics using data from 40 jurisdictions with complete laboratory reporting. The 40 jurisdictions contributing data include Alabama, Alaska, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the District of Columbia. As of December 2017, these jurisdictions required reporting of all levels of CD4 and viral load (VL) tests and had reported to CDC at least 95% of the test results they had received by December 2017 (for specimens collected from at least January 2015 through September 2017).

Receipt of HIV care, retention in HIV care (ie, receipt of continuous care), and viral suppression were based on data for all persons diagnosed with PHIV by year-end 2014 and alive at year-end 2015 in the 40 jurisdictions that reported complete CD4 and VL test results to CDC. Receipt of any HIV medical care was measured by documentation of ≥1 CD4 or VL tests performed during 2015; retention in HIV care was measured by documentation of ≥2 CD4 or VL tests performed at least 3 months apart during 2015. Viral suppression was defined as a VL result of <200 copies/mL at the most recent VL test during 2015, consistent with the definition used in the national indicator for viral suppression.[4] If the numerical VL result was missing, the result interpretation (eg, below limit) was used to determine viral suppression. Viral suppression was measured for the following populations: (1) among persons diagnosed with PHIV by year-end 2014 and alive at year-end 2015, (2) among persons with diagnosed PHIV by year-end 2014 who were alive at year-end 2015 and received any HIV care in 2015 (≥1 CD4 or VL test during 2015), and (3) among persons with diagnosed PHIV by year-end 2014 who were alive at year-end 2015 and had ≥1 VL tests during 2015. Persons with no VL tests in 2015 were presumed not to be suppressed and were excluded from the numerator.

All data displayed are unadjusted. Data were stratified by age group (aged <6, 6–12, 13–17, 18–25, ≥26 years), sex at birth, race/ethnicity [black/African American (hereafter referred to as black), white, Hispanic/Latino, other (American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander, and multiple races)], region of residence [Northeast, Midwest, South, West, US dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands)], and country of birth (US-born, non–US-born, and unknown). We defined US-born as persons born in the 50 states, the District of Columbia, or a US dependent area. We defined non–US-born as persons born outside the 50 states, the District of Columbia, or US dependent areas. We excluded persons born before 1978 from this analysis, as the first cases of PHIV in the United States are thought to have occurred in 1978 on the basis of modelling.[16] Prevalence ratios (PRs) with 95% confidence intervals (CIs) were derived from binomial regression models and calculated on the probability of receiving any HIV care, being retained in care, or being virally suppressed. All analyses were conducted using SAS 9.4 (SAS Institute, Inc., Cary, NC).

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