Background: The majority of persons diagnosed with HIV are residents of large metropolitan areas and many large metropolitan areas have implemented intensified HIV testing programs. Yet many persons are diagnosed with late stage disease (stage 3, AIDS).
Methods: Using data reported through December 2013 from the National HIV Surveillance System, we determined the percentage of persons diagnosed with late stage disease (stage 3 based on CD4 count <200 cells/mL or opportunistic illness within 3 months of HIV diagnosis) among persons diagnosed with HIV during 2012 in metropolitan statistical areas (MSAs) (population ≥500,000, including individual MSAs; and population 50,000 to 499,999) and non-metropolitan areas. We also determined trends in late diagnosis from 2003-2012 and assessed change using linear regression. Data were statistically adjusted for missing HIV transmission categories.
Results: Overall, 24% of persons diagnosed in 2012 in the Unites states had a late diagnosis; 23.3% in large MSAs, 26.3% in small to medium MSAs, and 29.7% in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.5% in Birmingham-Hoover, AL to 44.4% in Modesto, CA. In large MSAs, overall the percentage diagnosed late was 22.7% for blacks/African Americans, 24.7% for Hispanics/Latinos, and 23.1% for whites; however, in some MSAs a higher percentage of blacks/African Americans was diagnosed late compared with Hispanics/Latinos or whites (e.g., New York MSA, 23.9%, 20.8%, 18.2%, respectively). In the majority of large MSAs, persons with infection attributed to male-to-male sexual contact had a lower percentage diagnosed late compared to persons with infection attributed to injection-drug use or heterosexual contact. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2% to 23.3%), smaller MSAs (33.4% to 26.3%), and non-metropolitan areas (33.3% to 29.7%); however, the percentage remained stable since 2008 in non-metropolitan areas. Significant decreases (P<0.01) occurred in 41 of 105 large MSAs overall and among men who have sex with men.
Conclusions: During the past decade, the percentage of persons with a late HIV diagnosis decreased overall and in many individual areas with high HIV burden. However, even in areas with intensified HIV testing interventions, about 1 in 5 persons were diagnosed with advanced disease. In addition, there are disparities by race/ethnicity and transmission risk group in some areas.