Speaker
Description
Between 2010 and 2019, new HIV diagnoses in the United States declined 14.8% from 42,665 to 36,349 diagnoses. The federal Ending the HIV Epidemic (EHE) Initiative was developed in 2019 to accelerate the decline of annual HIV diagnoses in the United States by 90% by 2030. In 2020, the number of HIV diagnoses fell by 16.4%, coinciding with the first waves of the COVID-19 pandemic. However, HIV diagnoses in the United States in 2024 reflected a 6% increase since 2019.
We investigated whether this recent increase in HIV diagnoses was reflective of (i) delayed diagnosis of people who acquired HIV during or before 2020 but did not seek HIV testing or (ii) an increase in HIV transmission since 2020. We did this by analyzing public health surveillance data for 23,619 people diagnosed in New York City (NYC) between 2009-2024 with a reported HIV-1 subtype B sequence (prot/RT). We inferred a maximum likelihood tree in FastTree2 and inferred the age of internal nodes using TreeTime. To characterize the relationship between HIV transmission and diagnosis, we identified virus from pairs of individuals who were both diagnosed within a year of each other and shared a common ancestor within a year prior to the latter diagnosis date; this shared recent ancestor serves as a proxy for a recent transmission event followed by an HIV diagnosis. We then performed multivariate regression to determine whether the relationship between the inferred transmission events above annual diagnoses had changed since 2020; a change in this relationship post-2020 would indicate a shift in the number of delayed diagnoses.
Based on the projected linear trend of decreasing HIV diagnoses in NYC between 2010-2019, there was an excess of 1,631 (95% CI: 973–2289) subtype B diagnoses between 2020-2024, roughly equivalent to the annual number of new diagnoses in NYC in recent years. We were unable to detect a change in the relationship between annual diagnoses and transmission events post-2020, suggesting that the recent rise in diagnoses is indicative of an increase in HIV transmission and not a product of increased delayed diagnoses. This finding was consistent after controlling for race/ethnicity, transmission category, country of birth, and age at diagnosis and in down-sampled replicates (n=10; adjusting for the variation in HIV-1 sequence reporting completeness over the analytic period), and after exploring transmission in a 2-year window prior to the diagnoses. We validated our approach for identifying recent transmission events, demonstrating that people diagnosed following these events were more likely to be diagnosed with an acute HIV infection (Odds Ratio: 1.48; p<0.001).
This analysis suggests the post-2020 increase in HIV diagnoses may reflect an increase in new HIV infections and not delayed diagnosis of previously acquired infections, a situation that requires continued surveillance and investigation to ensure NYC’s progress toward EHE goals.
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