Progression from HIV to AIDS

Percent 20% 18% 16% 14% 12% 10% 8% 6% 4% Figure 1.22. Rolling Three Year Average of Deaths Among Persons Diagnosed with HIV by Year of Death and Mode of Exposure, Orange County, 2008-2018

2% 0%

2009-2011 2010-2012 2011-2013 2012-2014 2013-2015 2014-2016 2015-2017 2016-2018 MSM 64.7% 59.8% 58.1% 63.3% 67.1% 68.7% 64.6% 61.3% Heterosexual 7.5% 8.3% 9.8% 9.6% 7.8% 8.3% 8.9% 8.9% IDU 15.9% 19.7% 20.0% 17.5% 14.5% 11.7% 11.1% 13.3% MSM/IDU 8.7% 9.4% 9.1% 7.2% 7.5% 7.9% 10.0% 11.1%

Deaths in 2018 are provisional due to reporting delays.

The introduction of Highly Active Antiretroviral Therapy (HAART) in 1995 substantially prolonged the interval between the diagnosis of HIV infection and the development of AIDS.15 Since 1996, Orange County has reported 4,439 AIDS cases. In addition to HAART, other measures that help delay the progression to AIDS are:

• Early identification of HIV diagnosis: Testing individuals for HIV so that they know their HIV status and

can be linked to care at the earliest possible stage of their HIV infection;

• Linkage to care: Ensuring that the newly diagnosed individual gets linked to HIV medical care; • Retention in care: Ensuring that person currently in HIV medical care continue with their HIV medical care.

Figure 1.23 shows the proportion of individuals who were diagnosed with HIV at the same time (concurrently) as AIDS for persons who received their diagnoses after 1995 (since the introduction of HAART). The proportion of all individuals who were concurrently diagnosed with HIV and AIDS was 52.5%. The proportion of males, Hispanics, Asians, and those who reported exposure through MSM or heterosexual contact received concurrent HIV and AIDS diagnoses at a rate higher than the overall proportion. This indicates that these populations are living longer with HIV before diagnosis and are not getting tested until the disease has begun the progression to AIDS.

15 Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001;91:1060—8. Health Promotion and Community Planning Division 26 HIV/AIDS Surveillance and Monitoring