Estimated time from HIV infection to diagnosis and diagnosis to first viral suppression during 2014-2018

Objective: To examine changes in the lengths of time from HIV infection to diagnosis (Infx-to-Dx) and from diagnosis to first viral suppression (Dx-to-VS), two periods during which HIV can be transmitted. Design: Data from the National HIV Surveillance System (NHSS) for persons who were aged at least 13 years at the time of HIV diagnosis during 2014-2018 and resided in one of 33 United States jurisdictions with complete laboratory reporting. Methods: The date of HIV infection was estimated based on a CD4(+)-depletion model. Date of HIV diagnosis, and dates and results of first CD4(+) test and first viral suppression (<200 copies/ml) after diagnosis were reported to NHSS through December 2019. Trends for Infx-to-Dx and Dx-to-VS intervals were examined using estimated annual percentage change. Results: During 2014-2018, among persons aged at least 13 years, 133 413 HIV diagnoses occurred. The median length of infx-to-Dx interval shortened from 43 months (2014) to 40 months (2018), a 1.5% annual decrease (7% relative change over the 5-year period). The median length of Dx-to-VS interval shortened from 7 months (2014) to 4 months (2018), an 11.4% annual decrease (42.9% relative change over the 5-year period). Infx-to-Dx intervals shortened in only some subgroups, whereas Dx-to-VS intervals shortened in all groups by sex, transmission category, race/ethnicity, age, and CD4(+) count at diagnosis. Conclusion: The shortened Infx-to-Dx and Dx-to-VS intervals suggest progress in promoting HIV testing and earlier treatment; however, diagnosis delays continue to be substantial. Further shortening both intervals and eliminating disparities are needed to achieve Ending the HIV Epidemic goals. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights reserved.