Examining Survival of People Diagnosed With HIV in Florida Between 2015 and 2021 After a Late, Delayed, or Timely Diagnosis.

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 to 2021.

SETTING

Using data from the Florida Enhanced HIV/AIDS Reporting System, we included 24,374 individuals with at least 3 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 with timely diagnosis, the hazard of death was significantly higher for late (hazard ratio = 2.18, 95% confidence interval: 1.89 to 2.52) and delayed (hazard ratio = 1.25, 95% confidence interval: 1.03 to 1.52) diagnoses. Female sex and older age were associated with increased mortality, whereas Hispanic and non-Hispanic Black individuals had lower mortality risks.

CONCLUSIONS

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.