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  Reported by Jules Levin
IDWeek Oct 26-30
New Orleans 2016
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Women Account for Virtually Half of New HIV in Bronx Group in Regular Care
  IDWeek 2016, October 26-30, 2016, New Orleans
Mark Mascolini
Among HIV-negative people in routine care at a Bronx medical center, clinicians diagnosed 220 new HIV infections over 5 years [1]. Unlike most other high-risk groups in both local and national surveillance, women accounted for virtually half of the new HIV infections. Both women and men had healthcare visits between their last negative HIV test and first positive test, a finding suggesting missed opportunities to diagnose HIV.
For several years the CDC has recommended opt-out HIV screening for everyone between 13 and 64 years old at least once as part of regular health care [2]. Many people in routine care never get tested, and a portion of high-risk people get tested too infrequently. Clinicians at Montefiore Health System in the Bronx, New York, focused on adults in regular care to determine how often they got tested for HIV and how often they got diagnosed.
Montefiore tests more than 50,000 people for HIV every year in a part of New York City where HIV prevalence stands at 2%. They identified people at least 18 years old who had at least one negative HIV test followed by a positive test sometime from 2009 through 2014. In that span they diagnosed 220 new cases of HIV infection, about half in people under 30 years old but more than 10% in those 50 or older. About 50% of people testing positive were black and about 40% Hispanic. Heterosexual sex was the dominant HIV risk factor, in about 45%, followed by sex between men in about 30% and drug injection in about 25%. The proportion of people infected during sex between men and women rose significantly from 2009 through 2014 (P = 0.03).
Among the 220 HIV seroconverters, 105 (48%) were women. A higher proportion of women than men had only one negative HIV test before their positive test (55% versus 43%, P = 0.045), and women made twice as many visits between their last negative test and positive test (median 4 versus 2, P < 0.001). About 1 year passed between negative tests for both women and men. A much lower proportion of women than men reported noninjection illicit drug use before seroconversion (28% versus 45%, P = 0.021). About 40% of both women and men had a sexually transmitted infection before HIV seroconversion, and about 10% of women and men had mental illness before seroconversion.
About 70% of women versus 20% of men got linked to care during the study period, yet CD4 count at diagnosis was significantly higher in women than men (about 600 versus 500, P = 0.028). Most women and men tested positive during routine screening, though 9 people got tested during acute HIV infection and 3 with an active opportunistic infection. No one who tested positive was using PrEP.
The Montefiore team underlined the multiple healthcare visits many seroconverters had between their last negative test and HIV diagnosis--visits that may represent missed opportunities for HIV diagnosis. The investigators advised that "health systems must recognize at-risk populations that are actively accessing care despite not fitting the traditional risk profile and should tailor prevention strategies accordingly."
1. Cossarini F, Hanna D, Ginsberg M, Anastos K, Felsen U. Characteristics of patients who acquired HIV infection despite accessing healthcare: implications for HIV prevention strategies. IDWeek 2016, October 26-30, 2016, New Orleans. Abstract 477.
2. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. September 22, 2006 / 55(RR14);1-17. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm