title: Impact of accelerated progression to AIDS on public health monitoring of late HIV diagnosis.
abstract: Some patients develop AIDS within a year of HIV infection ("accelerated progression"). Classifying such cases as late HIV diagnosis may lead to inaccurate evaluation of HIV testing efforts. We sought to determine this group's contribution to overall late diagnosis rates. To identify cases of accelerated progression (development of AIDS within 12 months of a negative HIV test), we reviewed published HIV seroconverter cohort studies and used New York City's (NYC) HIV/AIDS surveillance registry. From the literature review, three seroconverter cohort studies revealed that 1.0-3.6% of participants had accelerated progression to AIDS. Applying this frequency estimate to the number of new infections in NYC (4762) for 2006 calculated by the Centers for Diseases Control and Prevention's incidence formula, we estimated that 3.6-13.0% of 1317 NYC HIV cases who are diagnosed with AIDS within 12 months of HIV diagnosis are accelerated progressors, not persons HIV infected for many years who did not test and present with AIDS (i.e., delayed diagnosis). In addition, our analysis of the 2006 NYC surveillance registry confirmed the occurrence of accelerated progression in a population-based setting; 67 accelerated progressors were reported and 9 (13%) could be confirmed through follow-up medical record review. With increased HIV testing initiatives, the irreducible proportion of AIDS cases with accelerated progression must be considered when interpreting late diagnosis data.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 10013, USA. cjain@health.nyc.gov
authors.forename: Charulata J
authors.initials: CJ
authors.lastname: Sabharwal
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.forename: Reshma
authors.initials: R
authors.lastname: Mehta
authors.forename: Colin
authors.initials: C
authors.lastname: Shepard
authors.forename: Sara
authors.initials: S
authors.lastname: Bodach
authors.forename: Lucia
authors.initials: L
authors.lastname: Torian
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Begier
mesh_terms: D000465:Algorithms; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D011635:Public Health Administration; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors