HIV Epidemiology in NYS and NYC - New York State ...New HIV Diagnoses* by Race/Ethnicity, New York...

HIV Epidemiology in New York State and New York CityLou Smith, MD, MPHDirector, Division of Epidemiology, Evaluation and ResearchAIDS Institute, New York State Department of Health

Sarah Braunstein, PhD, MPHDirector, HIV Epidemiology and Field Services ProgramNew York City Department of Health and Mental Hygiene

Trends in HIV and AIDS Cases*New York State, 1984 - 2012

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

1984 1986 1988 1990 1992 1994 1996 1998 2000^ 2002 2004 2006 2008 2010 2012

Num

ber of PLWD

HI

Num

ber o

f AID

S D

iagn

oses

and

Dea

ths

People living withHIV (non-AIDS) atthe end of each yearNumber

diagnosed eachyear with AIDS

Number of deaths each year among AIDS cases

People living withAIDS at the end of

each year

*Data as of April 2014^HIV named reporting began in NYS in 2000;deaths among HIV and AIDS cases are reported starting in 2000. NYSDOH/AI/BHAE

Number of deathsamong HIV & AIDScases each year

New York State Mother-to-Child HIV Transmission Number and Rate of HIV Infected Infants by Year of Delivery, 1997* - 2013

11.5

8.7

6.9

3.6 3.8 3.2

1.22.6 2.3

1.7 1.4 1.32.1

0.7 1.3 0.8 0.5

0

2

4

6

8

10

12

0

20

40

60

80

100

120

Year of DeliveryNumber Rate

n=99 n=81 n=62 n=28 n=27 n=23 n=8 n=16 n=13 n=10 n=8 n=6 n=11 n=3 n=6 n=3 n=2

Num

ber o

f HIV

Infe

cted

Infa

nts

*1997 data is February – December n=Number of infected infants identified

NYSDOH/AI/BHAE

Legal Basis for HIV Surveillance in New York State• HIV Reporting and Partner Services Law implemented

June 1, 2000, required reporting to New York State• Medical providers required to report new diagnoses of HIV, AIDS,

and HIV-related illness and known sex or needle-sharing partners • Laboratories conducting HIV-related tests required to report results

• Changes in the reporting law have broadened the permissible uses of surveillance data• 2000 – 2010: HIV epidemiology, partner notification• 2010 – 2014: deduplication, assess comorbidity, direct health

department program needs• 2014: sharing with medical providers for linkage and retention

4

NYSDOH/AI/BHAE

New York State HIV Laboratory Reporting

6/2000 to 6/2005 6/2005 to presentHIV antibody WB or IFA

confirmed (+) tests

WB or IFA confirmed (+)

testsCD4 lymphocytes <500 cells/mm3

or <29%All values

HIV nucleic acid tests

Any detectable value All values

Resistance and subtype results Not reportable

Genotype nucleotide sequence

5

NYSDOH/AI/BHAE

Epidemiology of HIV in New York State

6

Trends in HIV and AIDS* New York State, 2002-2012

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Num

ber of PLWD

HI

Num

ber o

f HIV

Dia

gnos

es a

nd D

eath

s New HIV diagnoses

People living with HIV (non-AIDS)

Deathsamong persons

with HIV/AIDS

People living with AIDS

*Data as of April 2014. New HIV diagnoses include those diagnosed concurrently with AIDS.HIV named reporting began in NYS in 2000. NYSDOH/AI/BHAE

7

Age Distribution of Newly Diagnosed HIV* Cases New York State, 2012**

0

5

10

15

20

25

30

35

40

12 &under

13-19 20-29 30-39 40-49 50-59 60+

Perc

ent o

f Cas

es

Age (years) in 2012

Female

Male

N=3,316Average=36 yrs

*Regardless of subsequent or concurrent AIDS diagnosis**Data as of April 2014 NYSDOH/AI/BHAE

8

N = 743

N = 2,573

New HIV Diagnoses* by Race/Ethnicity,New York State, 2012**

Race/Ethnicity Number of HIV Diagnoses

% of Total HIV Diagnoses

Rate per 100,000

Population***

NYS Total 3,316 100% 16.7Non-Hispanic

White 672 20.3% 6.1

Non-Hispanic Black 1,393 42.0% 45.4

Hispanic 1,019 30.7% 27.0

Asian/PI 83 2.5% 4.5

Native Am 4 0.1% 5.1

Multi-race 145 4.4% --*Regardless of concurrent or subsequent AIDS diagnosis .**Data as of March 2014*** Age-standardized NYSDOH/AI/BHAE

9

Newly Diagnosed HIV Cases by Transmission RiskNew York State, 2002-2012*

0

1000

2000

3000

4000

5000

6000

2002 2004 2006 2008 2010 2012

MSM Fem. Pres. Het. Heterosexual UnknownIDU MSM/IDU Pediatric Blood Prod.

10

*December 2013 NYSDOH/AI/BHAE

Newly diagnosed HIV cases by county, 2012

11

Total # of newly diagnosed cases in NYS, 2012: 726(including inmates, excludes NYC)

Total # of newly diagnosed cases in NYS, 2012: 697(excluding inmates and NYC)

NYSDOH/AI/BHAE & NY LINKS

Median Initial* CD4 Count of Persons Newly Diagnosed with HIV: New York State 2006-2012

317320

331353 352

372372

0

50

100

150

200

250

300

350

400

2006 2007 2008 2009 2010 2011 2012

CD4 lymphocytes (cells/mm3)

12

*Includes only cases with CD4 count within 3 months of diagnosis. Cases that developed AIDS with 30 days of HIV diagnosis are included. Case data as of September 2013 with laboratory data as of November 2013.

Year of HIV Diagnosis

NYSDOH/AI/BHAE

Linkage to Care within 3 Months of HIV Diagnosis by Region: New York State - 2012

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Syracuse

Rochester

New York City

Nassau Suffolk

M. Hudson

L. Hudson

Buffalo

Binghamton*

Albany

New York State

% linked

13

NHAS 2015 Goal 85%

*Based on less than 20 persons. NYSDOH/AI/BHAE

Age Distribution of Persons Living with Diagnosed HIV Infection: New York State, December 2012*

0%

5%

10%

15%

20%

25%

30%

35%

<13 13-19 20-24 25-29 30-39 40-49 50-59 60+

Perc

ent o

f Cas

es

Age (years) in 2012

N=132,174Average= 47.9 yrs

*Data as of April 2014 NYSDOH/AI/BHAE

14

Time to AIDS Diagnosis for New HIV Cases that WereNot Concurrent HIV/AIDS Diagnoses, NYSby Year of HIV Diagnosis

0%

10%

20%

30%

40%

0 1 2 3 4 5 6 7 8 9 10 11

Cum

ulat

ive

Perc

ent

w/A

IDS

Dia

gnos

is

Years after HIV Diagnosis

20% of persons diagnosed with HIV (not AIDS) in 2002 had developed AIDS within 2 years. 2005

20062007

20082009

20102011

20042003

2002

15

NYSDOH/AI/BHAE

10% of persons diagnosed with HIV (not AIDS) in 2011 had developed AIDS within 2 years.

Cascade of HIV CareNew York State, 2012

154,000

132,000

86,000

75,000

68,000

0 50,000 100,000 150,000

Estimated HIV InfectedPersons

Persons Living w/ DiagnosedHIV Infection

Cases w/any HIV Care duringthe year*

Cases w/continuous careduring the year**

Virally suppressed ( n.d. or ≤200/ml) at test closest to

end-of-year

* Any VL or CD4 test during the year** At least 2 tests, at least 3 months apart

86% of infected

56% of infected65% of PLWDHI



79% of cases w/any care

16

Viral Suppression among Persons Living with Diagnosed HIV Infection by Risk and Race/Ethnicity: New York State, 2012

0% 10% 20% 30% 40% 50% 60% 70%

Unknown

Pediatric Risk

Blood Products

Female Pres. Het.

Heterosexual

MSM-IDU

IDU

MSM

Multirace**

Native Amer.*

Asian/PI

Hispanic

Black nonHispanic

White nonHispanic

% viral suppression

17

NYS average 51%

*Based on a small number of persons (n=100). **Multirace care measures are likely less reliable due to the method used to calculate multirace status.

Race/ethnicity

Risk

NYSDOH/AI/BHAE

Newly Diagnosed HIV CasesNew York State, 2002-2012

18

0

1,000

2,000

3,000

4,000

5,000

6,000

2002 2004 2006 2008 2010 2012

NYS

NYC

NYSexclNYC

NYSDOH/AI/BHAE*Data as of April 2014

Monitoring Progress Toward the End of

the HIV Epidemic in New York State: The view from NYC

Sarah L. Braunstein, PhD MPH Director, HIV Epidemiology and Field Services Program,

NYC Department of Health and Mental Hygiene

HIV in New York City, 1981-2012

Data reported to NYC DOHMH through June 30, 2013.

HIV in New York City, 1981-2012 2012: 3,141 new HIV diagnoses

1,889 new AIDS diagnoses 1,578 deaths among PWH (607 HIV-related)


New Diagnoses and Estimated Incidence in NYC, 2008-2012

4256 3936

3599 3474

3141

3584

3146

2733 2927

2076

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2008 2009 2010 2011 2012*

Year New diagnoses of HIV Estimated HIV incidence

Num

ber

*2012 incidence data are preliminary. Estimates generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing

Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.

Data as reported to NYC DOHMH by June 30, 2013. HIV diagnoses includes diagnoses of HIV without AIDS and HIV concurrent with AIDS.

Death rates are age-adjusted to the citywide population of PWHA in 2012. 2012 death data are incomplete.

• ZIP codes in the Chelsea-Clinton, Central Harlem-Morningside Heights and Washington Heights-Inwood neighborhoods had the highest HIV diagnosis rates.

• ZIP codes in Chelsea-Clinton, West Queens and East Harlem had the highest HIV prevalence

• ZIP codes in Bayside-Little Neck, Port Richmond and Canarsie-Flatlands had the highest mortality among persons with HIV.

Geographic Distribution of HIV in NYC, 2012

Age-adjusted Death Rates Among Persons with HIV in NYC, 2001-2012

Data reported to NYC DOHMH by June 30, 2014. *2012 Deaths are incomplete – deaths among persons with HIV occurring outside NYC are not included.

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*

Age-

adju

sted

dea

th ra

tes p

er 1

,000

mid

-yea

r PLW

HA

All-cause

Year of death

HIV-related

Non-HIV-related

162.9

104.1

62.0

25.9

0

30

60

90

120

150

180

Black Hispanic White API

HIV Diagnosis Rates Among Males and Females by Race/ethnicity in NYC, 2012

The HIV diagnosis rate among black males was over 1.5 times higher than the rate among Hispanic

males and over 2 times higher than the rate among white males.

56.4

19.4 4.6 2.6

0

30

60

90

120

150

180


The HIV diagnosis rate among black females was over 3 times higher than the rate among

Hispanic females and over 12 times higher than the rate among white females.

Data as reported to NYC DOHMH by June 30, 2013. API=Asian/Pacific Islander

New HIV Diagnoses Among Women in NYC, 2012

0

100

200

300

400

500

600

700

800

2008 2009 2010 2011 2012

Num

ber

Year of diagnosis


Heterosexual

Unknown risk

Injection drug use

35.8% decline overall

New HIV Diagnoses Among MSM in NYC, 2008-2012

1923

1803 1794 1802 1719

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2008 2009 2010 2011 2012

Year of diagnosis

Num

ber

10.6% decline


0

100

200

300

400

500

600

700

800

2008 2009 2012 2011 2012

New HIV Diagnoses Among MSM by Race/Ethnicity in NYC, 2008-2012


Year of diagnosis

Num

ber

Asian/Pacific Islander

Black

White

Hispanic

0

50

100

150

200

250

300

350

400

450

500

2008 2009 2012 2011 2012

New HIV Diagnoses Among MSM <30 in NYC, 2008-2012

Num

ber


Black

White

Hispanic

Year of diagnosis



0

50

100

150

200

250

300

350

400

2008 2009 2012 2011 2012

New HIV Diagnoses Among MSM >30 in NYC, 2008-2012


Num

ber


Black

White Hispanic

Year of diagnosis


Estimated HIV Incidence Among MSM in NYC, 2008-2012

1883

1664 1604

1748

1248

866

744 776

909

708

1008 913 830

843

514

0

500

1000

1500

2000

2500

2008 2009 2010 2011 2012*

Num

ber

Year Estimated HIV incidence among MSM overall Estimated HIV incidence among MSM <30Estimated HIV incidence among MSM ≥30

*2012 incidence data are preliminary. 1Estimates generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing

Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.

Acute HIV Infection by HIV Transmission Risk in NYC, 2008-2012

0

20

40

60

80

100

120

140

160

180

2008 2009 2010 2011 2012

MSM IDU Heterosexual Unknown

Num

ber

Year of diagnosis


Acute HIV Infection Among MSM by Age and Race/ethnicity in NYC, 2012

0

5

10

15

20

25

30

35


13-19 20-24 25-29 30+

Num

ber

Race/ethnicity


0%

20%

40%

60%

80%

100%

Estimated HIV-infected

Ever HIV-diagnosed

Ever linked toHIV care

Retained in HIVcare in 2012

Presumed everstarted on ART

Suppressed viral load (≤200

copies/mL) in 2012

Perc

enta

ge

100%

86% of infected

73% of infected

85% of

diagnosed 55% of

infected

74% of linked to

care

51% of infected

93% of

retained in care

41% of infected

82% of

started on ART

133,635

114,926

97,940

72,918 67,624

55,453

Largest gap: Linkage Retention

HIV Care Continuum for NYC, 2012

41% Suppressed

73% Linked

55% Retained


Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag. Data reported to NYC DOHMH by June 30, 2013.

Initiation of Care Within 3 Months of HIV Diagnosis in NYC, 2008–2012

59% 60% 62% 68% 69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008 2009 2010 2011 2012

Tim

ely

initi

atio

n of

car

e (%

)

Year of HIV diagnosis

23.4%

34.1%

27.7%

39.5%

30.0%

43.2%

34.1%

48.4%

41.1%

57.7%

44.0%

60.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

By 6months

By 12months

By 6months

By 12months

By 6months

By 12months

By 6months

By 12months

By 6months

By 12months

By 6months

By 12months

2007 2008 2009 2010 2011 2012

% V

irally

supp

ress

ed

As reported to NYC DOHMH by December 31, 2013.

Viral Suppression at 6 and 12 Months After HIV Diagnosis in NYC, 2007-2012

Thank you

HIV Epidemiology and Field Services Program, NYC DOHMH http://www.nyc.gov/html/doh/html/data/hivepi.shtml

HIV Epidemiology in NYS and NYC - New York State ...New HIV Diagnoses* by Race/Ethnicity, New York...

Documents

Transcript of HIV Epidemiology in NYS and NYC - New York State ...New HIV Diagnoses* by Race/Ethnicity, New York...