Background:  Since the introduction of named HIV reporting in 2000, more than one-quarter of New Yorkers newly diagnosed with HIV have been concurrently diagnosed with AIDS. Concurrent diagnosis of HIV/AIDS complicates treatment and increases mortality.  

Methods:  NYC HIV/AIDS Registry data were used to analyze the prevalence and distribution of concurrent HIV/AIDS in 2004. Concurrent HIV/AIDS was defined as a diagnosis of AIDS within 31 days of initial diagnosis of HIV. AIDS was defined as CD4 <200 cells mL³ (<14% of total lymphocytes) or a CDC-defined opportunistic illness.   

Results:  Overall, 28.5% of persons newly diagnosed with HIV in 2004 were concurrently diagnosed with AIDS. Concurrent HIV/AIDS was associated with age, increasing steadily from 17% in persons aged 20 to 29 to 26% in those aged 30 to 39 (AOR 1.6, 95%CI 1.3 to 2.0), 36% in those aged 40 to 49 (AOR 2.5, 2.0 to 3.1), 41% in those aged 50 to 59 (AOR 3.3, 2.3 to 4.9), and 45% in those aged 60+ (AOR 3.4, 2.3 to 5.0). Persons with heterosexual, probable heterosexual, or unknown transmission risk were significantly more likely than injecting drug users (IDU) or men who have sex with men (MSM) to have concurrent HIV/AIDS (34% vs 22%, AOR 1.6, 1.3 to 1.8); 26% of new HIV diagnoses were concurrent with AIDS in US-born vs 37% of diagnoses in foreign-born persons (AOR 1.6, 1.3 to 1.8). Foreign-born were at greater risk of concurrent HIV/AIDS than US-born with unknown, heterosexual, or probable heterosexual exposure (44% vs 30%, OR 1.6, 1.3 to 2.0).  

Conclusions:  Increasing age, unknown or heterosexual transmission risk, and foreign country of birth are associated with concurrent diagnosis of HIV/AIDS in NYC—possibly secondary to reduced access to or acceptance of testing or limited risk perception. Our data suggest that the current practice of targeted HIV testing does not result in timely diagnosis for persons who do not fit a “traditional” risk and age profiles or who do not actively seek testing. An HIV diagnosis that is delayed until development of immuno-depletion or opportunistic illness represents a public health failure that may be addressed by replacement of targeted testing with routine testing, and by implementation of initiatives to increase availability and reduce stigma associated with testing.