HIV Epidemiology
in New York State
Lou Smith, MD, MPH
Director, Division of Epidemiology, Evaluation and Research
AIDS Institute, New York State Department of Health
2
HIV Surveillance in New York State
• HIV Reporting and Partner Services Law
implemented June 1, 2000, required reporting to
New York State
– Laboratories conducting HIV-related tests required to
report results
– Medical providers required to report new diagnoses of
HIV, AIDS, and HIV-related illness and known sex or
needle-sharing partners
• Other sources of information
– Medical record review
– Public health database matches: vital statistics, Medicaid,
cancer registry, ADAP, etc.
– Feedback from data-to-care activities
2
Trends in HIV and AIDS Cases*
New York State, 1984 – 2013
14,000
12,000
10,000
140,000
People living with
HIV (non-AIDS)
at the end of
each year
Number
diagnosed each
year with AIDS
120,000
100,000
Deaths each
year among
AIDS cases
80,000
8,000
New HIV Diagnoses
Each Year
6,000
4,000
People living with
AIDS at the end
of each year
60,000
40,000
20,000
2,000
Deaths each year among
HIV & AIDS cases
0
^
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
*Data as of April 2015
^HIV named reporting began in NYS in 2000
0
Number of PLWDHI
Number of HIV & AIDS Diagnoses and Deaths
16,000
8
Age Distribution of Newly Diagnosed HIV* Cases
New York State, 2013**
25
N=3,512
Average=36.4 yrs
Percent of Cases
20
15
Male
Female
10
5
0
12 & 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
under
Age in 2013
*Regardless of subsequent or concurrent AIDS diagnosis
**Data as of April 2015
5
Newly Diagnosed HIV Cases by Year of Diagnosis
and Age, New York State, 2002-2013*
2,500
30-39
40-49
25-29
Number of Cases
2,000
20-24
50-59
60+
1,500
13-19
12 & under
1,000
500
0
2002
*Data as of April 2015
2004
2006
2008
2010
2012
6
Newly Diagnosed HIV Cases by Year of Diagnosis
and Race/Ethnicity, New York State, 2002-2013*
3,000
Black Not-Hispanic
Hispanic
White Not-Hispanic
2,500
Number of Cases
Multi-Race
Asian/PI
2,000
Native Am
1,500
1,000
500
0
2002
*Data as of April 2015
2004
2006
2008
2010
2012
7
Newly Diagnosed HIV Cases by Year of Diagnosis
and Transmission Risk, New York State, 2002-2013*
6,300
Number of Cases
5,400
4,500
3,600
2,700
1,800
900
0
2002
2004
2006
2008
2010
MSM
Unknown
Heterosexual
Fem. Pres. Het.
IDU
MSM/IDU
Pediatric
Blood Prod.
*Data as of April 2015
2012
8
Newly Diagnosed HIV Cases by County of Residence at Diagnosis
New York State, 2013 (Excludes New York City)
EXCLUDING prison inmates
INCLUDING prison inmates
NYS HIV surveillance data as of April, 2015. Maps created by NYLinks Evaluation Team May, 2015.
9
Median Initial* CD4 Count
Persons Newly Diagnosed with HIV New York
State, 2006-2013
400
350
CD4 count/mm3
300
356
315
325
2006
2007
375
375
378
354
333
CD4 lymphocytes (cells/mm3)
250
200
150
100
50
0
2008
2009
2010
Year of HIV Diagnosis
*Includes only cases with CD4 count within 3 months of diagnosis.
Cases that developed AIDS with 30 days of HIV diagnosis are included.
HIV case and laboratory data as of April 2015.
2011
2012
2013
10
Linkage to Care within 3 Months of HIV
Diagnosis by Region New York State, 2013
% Linked
NHAS 2015
Goal 85%
New York State
Albany
Binghamton*
Buffalo
L. Hudson
M. Hudson
Nassau Suffolk
New York City
Rochester
Syracuse
0%
20%
*Based on less than 20 persons.
40%
60%
80%
100%
11
New York State Estimated New HIV Infections:
2006-2013
Estimated HIV Incidence Rate (NYS)
Estimated New HIV Infections (NYS)
40.0
6,500
37.8
6,125
35.2
5,682
35.0
5,500
Rate (per 100,000)
Estimated Number
6,000
5,191
4,933
5,000
4,500
4,829
4,240
4,209
4,184
4,257
4,000
3,977
3,631
3,500
3,509
3,628 3,472
3,385
32.0
30.1
30.0
29.9
25.9
25.0
25.5
25.6
26.3
24.6
22.1
21.5
22.1
21.0
20.4
21.6
20.0
18.1
3,547
3,000
3,052
2,500
3,051
3,072
2,593
3,000
18.6
2,925
2,527
2,464
2012
2013
2,000
15.0
18.7
17.6
18.7
15.9
15.3
14.8
2012
2013
10.0
2006
2007
2008
2009
2010
2011
Produced June 2015 based on January 2015 data
2006
2007
2008
2009
2010
2011
12
New York State Estimated New HIV Infections
by Risk: 2006 - 2013
Proportion of HIV Incidence Estimates by
Risk
NYS Estimated New HIV Infections by Risk
3,500
100%
Incidence Estimate
3,000
90%
Other Risks
80%
2,500
70%
2,000
IDU
60%
50%
1,500
40%
1,000
MSM
30%
500
20%
0
10%
2006
2007
2008
MSM
2009
IDU
2010
2011
Other
Produced June 2015 based on January 2015 data
2012
2013
0%
2006
2007
2008
2009
2010
2011
2012
2013
13
New York State Cascade of HIV Care, 2013
Persons Diagnosed in NYS &† Living at End of 2013
0
40,000
80,000 120,000 160,000
Estimated HIV Infected Persons
155,000
Persons Living w/ Diagnosed HIV
Infection
Cases w/any HIV Care during the
year*
134,000 86% of infected
86,000 55% of infected
64% of PLWDHI
Cases w/continuous care during the
year**
74,000 48% of infected
Virally suppressed ( n.d. or ≤200/ml)
at test closest to end-of-year
70,000 45% of infected
55% of PLWDHI
52% of PLWDHI
82% of cases w/any care
* Any VL or CD4 test during the year
** At least 2 tests, at least 3 months apart
† Persons with residence in NYS at the time of diagnosis alive as of December 31, 2013
14
Old and new style Cascade populations
Persons diagnosed in
NYS and living 12/2013
133,400
1. Remove persons with recent
non-NYS address
1,600
2. Add persons diagnosed in another
state with recent NYS address
5,800
3. Remove (a) persons with AIDS with no
evidence of care for 5 years, and
(b) persons with diagnosed HIV (non-AIDS)
with no evidence of care for 8 years.
Persons living with diagnosed
HIV in NYS, 12/2013
112,400
25,200
15
New York State Cascade of HIV Care, 2013
Persons Residing in NYS† at End of 2013
0
40,000
80,000 120,000 160,000
Estimated HIV Infected Persons
131,000
Persons Living w/ Diagnosed HIV
Infection
Cases w/any HIV Care during the
year*
Cases w/continuous care during the
year**
Virally suppressed ( n.d. or ≤200/ml)
at test closest to end-of-year
112,000 86% of infected
87,000 66% of infected
77% of PLWDHI
74,000 57% of infected
66% of PLWDHI
71,000 54% of infected
* Any VL or CD4 test during the year
** At least 2 tests, at least 3 months apart
† Based on most recent known address, regardless of where diagnosed.
Excludes persons with AIDS with no evidence of care for 5 years and persons with
diagnosed HIV (non-AIDS) with no evidence of care for 8 years.
63% of PLWDHI
82% of cases w/any care
16
Viral Suppression among Persons Living with Diagnosed
HIV Infection by Ryan White Region
New York State, 2013
% Viral Suppression
NYS average 63%
Syracuse
Rochester
New York City
Nassau Suffolk
M. Hudson
L. Hudson
Buffalo
Binghamton
Albany
0%
10%
20%
30%
40%
50%
60%
New York State and region residence based on most recent address known to NYSDOH Bureau of HIV/AIDS Epidemiology.
70%
17
Viral Suppression among Persons Living with Diagnosed HIV
Infection by Risk and Race/Ethnicity: New York State, 2013
% Viral Suppression
Race/ethnicity
NYS average 63%
White nonHispanic
Black nonHispanic
Hispanic
Asian/PI
Native Amer.*
Multirace**
Risk
MSM
IDU
MSM-IDU
Heterosexual
Female Pres. Het.
Blood Products
Pediatric Risk
Unknown
0%
10%
20%
30%
40%
50%
60%
*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.
New York State residence based on most recent address known to NYSDOH Bureau of HIV/AIDS Epidemiology.
70%
18
Deaths Among Reported HIV and AIDS Cases by
Year of Death, New York State, 2002-2013*
3,500
Deaths Among Reported
AIDS Cases
Deaths Among Reported
HIV Cases
Number of Deaths
3,000
2,500
2,000
1,500
1,000
500
0
2002
*Data as of April 2015
2004
2006
2008
2010
2012
19
Newly Diagnosed HIV Cases by Year of Diagnosis
and Region, New York State, 2002-2013*
7,000
NYS
NYC
6,000
NYS excl NYC
5,000
4,000
3,000
2,000
1,000
0
2002
*Data as of April 2015
2004
2006
2008
2010
2012
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Questions ?
Lou Smith, MD, MPH
[email protected]
518.474.7238
20