HIV Epidemiology in New York State

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

Number of HIV & AIDS Diagnoses and Deaths 2 Trends in HIV and AIDS Cases* New York State, 1984 2013 16,000 14,000 12,000 10,000 8,000 6,000 4,000 Number diagnosed each year with AIDS Deaths each year among AIDS cases People living with AIDS at the end of each year People living with HIV (non-aids) at the end of each year New HIV Diagnoses Each Year 140,000 120,000 100,000 80,000 60,000 40,000 Number of PLWDHI 2,000 0 Deaths each year among HIV & AIDS cases ^ 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 20,000 0 *Data as of April 2015 ^HIV named reporting began in NYS in 2000

Percent of Cases 8 Age Distribution of Newly Diagnosed HIV* Cases New York State, 2013** 25 N=3,512 Average=36.4 yrs 20 15 10 Male Female 5 0 12 & under 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Age in 2013 *Regardless of subsequent or concurrent AIDS diagnosis **Data as of April 2015

Number of Cases Newly Diagnosed HIV Cases by Year of Diagnosis and Age, New York State, 2002-2013* 5 2,500 2,000 1,500 30-39 40-49 25-29 20-24 50-59 60+ 13-19 12 & under 1,000 500 0 2002 2004 2006 2008 2010 2012 *Data as of April 2015

Number of Cases Newly Diagnosed HIV Cases by Year of Diagnosis and Race/Ethnicity, New York State, 2002-2013* 6 3,000 2,500 2,000 Black Not-Hispanic Hispanic White Not-Hispanic Multi-Race Asian/PI Native Am 1,500 1,000 500 0 2002 2004 2006 2008 2010 2012 *Data as of April 2015

Number of Cases Newly Diagnosed HIV Cases by Year of Diagnosis and Transmission Risk, New York State, 2002-2013* 6,300 5,400 4,500 7 3,600 2,700 1,800 900 0 2002 2004 2006 2008 2010 2012 MSM Unknown Heterosexual Fem. Pres. Het. IDU MSM/IDU Pediatric Blood Prod. *Data as of April 2015

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.

Median Initial* CD4 Count Persons Newly Diagnosed with HIV New York State, 2006-2013 400 9 CD4 count/mm 3 350 300 250 200 150 100 315 325 333 356 354 375 375 378 CD4 lymphocytes (cells/mm3) 50 0 2006 2007 2008 2009 2010 2011 2012 2013 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.

10 Linkage to Care within 3 Months of HIV Diagnosis by Region New York State, 2013 New York State Albany Binghamton* Buffalo L. Hudson M. Hudson Nassau Suffolk New York City Rochester Syracuse % Linked NHAS 2015 Goal 85% 0% 20% 40% 60% 80% 100% *Based on less than 20 persons.

Estimated Number Rate (per 100,000) 11 New York State Estimated New HIV Infections: 2006-2013 Estimated New HIV Infections (NYS) Estimated HIV Incidence Rate (NYS) 6,500 6,125 40.0 37.8 6,000 5,682 35.0 35.2 5,500 5,000 5,191 4,933 30.0 29.9 32.0 30.1 4,500 4,829 4,209 4,240 4,184 25.0 26.3 25.9 25.6 25.5 4,000 3,500 3,000 2,500 3,977 4,257 3,547 3,509 3,631 3,628 3,472 3,385 3,051 3,000 3,052 3,072 2,925 2,593 2,527 2,464 20.0 15.0 24.6 21.6 22.1 18.6 21.5 18.7 15.9 22.1 18.7 21.0 18.1 15.3 20.4 17.6 14.8 2,000 2006 2007 2008 2009 2010 2011 2012 2013 10.0 2006 2007 2008 2009 2010 2011 2012 2013 Produced June 2015 based on January 2015 data

Incidence Estimate 12 New York State Estimated New HIV Infections by Risk: 2006-2013 3,500 NYS Estimated New HIV Infections by Risk 100% Proportion of HIV Incidence Estimates by Risk 3,000 90% Other Risks 2,500 80% 2,000 70% 60% IDU 1,500 1,000 500 50% 40% 30% 20% MSM 0 2006 2007 2008 2009 2010 2011 2012 2013 MSM IDU Other 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 Produced June 2015 based on January 2015 data

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 134,000 86% of infected 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 86,000 74,000 70,000 * 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 55% of infected 64% of PLWDHI 48% of infected 55% of PLWDHI 45% of infected 52% of PLWDHI 82% of cases w/any care

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 2. Add persons diagnosed in another state with recent NYS address 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. 1,600 5,800 25,200 Persons living with diagnosed HIV in NYS, 12/2013 112,400

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 112,000 86% of infected 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 87,000 74,000 71,000 * 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. 66% of infected 77% of PLWDHI 57% of infected 66% of PLWDHI 54% of infected 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 Syracuse Rochester New York City Nassau Suffolk M. Hudson L. Hudson Buffalo Binghamton Albany % Viral Suppression NYS average 63% 0% 10% 20% 30% 40% 50% 60% 70% New York State and region residence based on most recent address known to NYSDOH Bureau of HIV/AIDS Epidemiology.

Viral Suppression among Persons Living with Diagnosed HIV Infection by Risk and Race/Ethnicity: New York State, 2013 Race/ethnicity White nonhispanic Black nonhispanic Hispanic Asian/PI Native Amer.* Multirace** Risk MSM IDU MSM-IDU Heterosexual Female Pres. Het. Blood Products Pediatric Risk Unknown % Viral Suppression 0% 10% 20% 30% 40% 50% 60% 70% *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. 17 NYS average 63%

Number of Deaths Deaths Among Reported HIV and AIDS Cases by Year of Death, New York State, 2002-2013* 18 3,500 3,000 2,500 Deaths Among Reported AIDS Cases Deaths Among Reported HIV Cases 2,000 1,500 1,000 500 0 2002 2004 2006 2008 2010 2012 *Data as of April 2015

Newly Diagnosed HIV Cases by Year of Diagnosis and Region, New York State, 2002-2013* 19 7,000 6,000 5,000 NYS NYC NYS excl NYC 4,000 3,000 2,000 1,000 0 2002 2004 2006 2008 2010 2012 *Data as of April 2015

20 Questions? Lou Smith, MD, MPH lou.smith@health.ny.gov 518.474.7238 20