Examining Survival of People Diagnosed with HIV in Florida Between 2015-2021 Following a Late, Delayed, or Timely Diagnosis

Abstract

Introduction: Late HIV diagnosis is a global concern linked to poor health outcomes and is a barrier to ending the HIV epidemic. However, differences in survival outcomes between late and delayed diagnoses remain unclear in the era of effective treatments. This study examined all-cause mortality among individuals with late (CD4 <200 cells/μL), delayed (200≤CD4<350 cells/μL), or timely (CD4≥350 cells/μL) HIV diagnoses in Florida from 2015-2021.

Setting: Using data from the Florida Enhanced HIV/AIDS Reporting System (eHARS), we included 24,374 individuals with at least three CD4 tests. Mortality data were linked through the National Death Index and Social Security Death Index.

Methods: Cox proportional hazards models and Kaplan-Meier curves assessed mortality risk, adjusting for age, year of diagnosis, race/ethnicity, and sex.

Results: Among participants (mean age 37.1 years; 20% female; 39% non-Hispanic Black; 34% Hispanic; 25% non-Hispanic White), 895 deaths (4%) occurred. Late and delayed diagnoses accounted for 23% and 18% of cases, respectively. Compared to timely diagnosis, the hazard of death was significantly higher for late (HR=2.18, 95% CI: 1.89-2.52) and delayed (HR=1.25, 95% CI: 1.03-1.52) diagnoses. Female sex and older age were associated with increased mortality, while Hispanic and non-Hispanic Black individuals had lower mortality risks.

Conclusion: Late and delayed HIV diagnoses were associated with elevated mortality risk, with late diagnosis posing the greatest risk. These findings underscore the need for earlier HIV detection and intervention to improve survival outcomes.

Figure 1.

Adjusted survival analysis by HIV diagnosis status, considering all-cause mortality from 2015 to 2021. Diagnosis status was categorized as late (CD4 <200 cells/μL), delayed (200 ≤ CD4 <350 cells/μL), or timely (CD4 ≥350 cells/μL) based on the first CD4 test following diagnosis.