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Examining Survival of People Diagnosed with HIV in Florida Between 2015-2021 Following a Late, Delayed, or Timely Diagnosis
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December 10, 2025
Those with a late diagnosis had a 2.18 times higher all-cause mortality rate and those with a delayed diagnosis had a 1.25 times higher all-cause mortality rate. Approximately 70% of HIV-associated deaths occurred among individuals with a late HIV diagnosis, and both delayed and late diagnoses were linked to an increased hazard of HIV-related mortality. this could lead to thousands of excess deaths nationally.
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.
Compared to the year 2015, only the years 2019 (1.37 [95% CI: 1.06-1.76]) and 2020 (1.57 [95% CI: 1.10-2.23]) were significantly associated with all-cause mortality. No other years (2016, 2017, 2018, 2021) had a significant association.
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.
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