Human Immunodeficiency Virus Infection Newly Diagnosed at Autopsy in New York City, 2008–2012

Background. Studying the most extreme example of late diagnosis, new HIV diagnoses after death, may be instructive to HIV testing efforts. Using the results of routine HIV testing of autopsies performed by the Office of Chief Medical Examiner (OCME), we identified new HIV diagnoses after death in New York City (NYC) from 2008 to 2012.

Methods. Population-based registries for HIV and deaths were linked to identify decedents not known to be HIV-infected before death. Multivariable logistic regression models were constructed to determine correlates of a new HIV diagnosis after death among all persons newly diagnosed with HIV and among all HIV-infected decedents receiving an OCME autopsy.

Results. Of 264 893 deaths, 24 426 (9.2%) were autopsied by the NYC OCME. Of these, 1623 (6.6%) were infected with HIV, including 142 (8.8%) with a new HIV diagnosis at autopsy. This represents 0.8% (142 of 18 542) of all new HIV diagnoses during the 5-year period. Decedents newly diagnosed with HIV at OCME autopsy were predominantly male (73.9%), aged 13–64 years (85.9%), non-white (85.2%), unmarried (81.7%), less than college educated (83.8%), and residents of an impoverished neighborhood (62.0%). Of all HIV-infected OCME decedents aged ≥65 years (n = 71), 22.0% were diagnosed at autopsy. The strongest independent correlate of new HIV diagnosis at autopsy in both multivariable models was age ≥65 years.

Conclusions. Human immunodeficiency virus diagnoses first made after death are rare, but, when observed, these diagnoses are more commonly found among persons ≥65 years, suggesting that despite highly visible efforts to promote HIV testing community-wide, timely diagnosis among older adults living in impoverished, high-prevalence neighborhoods may require additional strategies.

Table 1.

Newly Diagnosed HIV Infection at OCME Autopsy Among All Newly Diagnosed Persons 13 Years and Older in NYC, 2008–2012

	All New HIV Infections		Newly Diagnosed HIV Infection						AOR (95% CI)	P Value
			At OCME Autopsy			During Life
	N	%	N	Column %	Row %	N	Column %	Row %
Total	18 542	100	142	100	0.77	18 400	100	99.23	—	—
Sex
Male	14 443	77.89	105	73.94	0.73	14 338	77.92	99.27	0.96 (.65–1.42)	.84
Female	4099	22.11	37	26.06	0.9	4062	22.08	99.1	Ref	Ref
Age
13–64	18 152	97.9	122	85.92	0.67	18 030	97.99	99.33	Ref	Ref
≥65	390	2.1	20	14.08	5.13	370	2.01	94.87	7.67 (4.70–12.51)	<.0001
Race/ethnicity
Black, non-Hispanic	8664	46.73	74	52.11	0.85	8590	46.68	99.15	1.30 (.74–2.28)	.37
Hispanic	5787	31.21	41	28.87	0.71	5746	31.23	99.29	1.22 (.71–2.12)	.47
White, non-Hispanic	3420	18.44	21	14.79	0.18	3399	18.47	99.39	Ref	Ref
Other	671	3.62	6	4.23	3.13	665	3.61	99.11	1.83 (.75–4.42)	.18
Neighborhood poverty level
Low poverty (<10% below FPL)	1728	9.32	6	4.23	0.35	1722	9.36	99.65	Ref	Ref
Medium (10% to <20% below FPL)	4814	25.96	33	23.24	0.69	4781	25.98	99.31	1.35 (.64–2.84)	.43
High (20% to <30% below FPL)	4720	25.46	43	30.28	0.91	4677	25.42	99.09	1.82 (.88–3.78)	.11
Very high poverty (≥30% below FPL)	4499	24.26	45	31.69	1	4454	24.21	99	1.68 (.80–3.53)	.17
Area-based poverty level not available	2781	15	15	10.56	0.54	2766	15.03	99.46	0.69 (.24–1.97)	.49

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; FPL, federal poverty level; HIV, human immunodeficiency virus; NYC, New York City; OCME, Office of Chief Medical Examiner; Ref, reference.

The text in bold are statistically significant.

Full article at:  http://goo.gl/cdts2K

By:  Chitra Ramaswamy,1 Tanya M. Ellman,3,4 Julie Myers,1,3 Ann Madsen,2 Kent Sepkowitz,5 and Colin Shepard1

¹Bureau of, HIV/AIDS Prevention and Control

²Office of Vital Statistics, New York City Department of Health and Mental Hygiene, Long Island City

³Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons

⁴ICAP, Columbia University, Mailman School of Public Health

⁵Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York

Correspondence: Chitra Ramaswamy, MD, DcGo, MPH, Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22nd Floor, Long Island City, New York 11101 (Email: vog.cyn.htlaeh@awsamarc).

 

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