Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus.
4 affiliations
- 1Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
- 2Boston Medical Center, Section of Infectious Diseases, Boston, Massachusetts.
- 3Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
- 4Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts.
Abstract
Introduction
Since 2019, transmission risk factors among patients diagnosed with HIV have changed, although the trends and reasons behind them have not been fully elucidated. The objective of this study was to assess changes in HIV transmission risk factors among patients newly diagnosed with HIV to inform future targeted HIV testing programs.Methods
This study site is New England's largest essential hospital and a major reporter of new HIV cases in Massachusetts. We performed a retrospective chart review of patients diagnosed with HIV infection at our medical center between January 2019 and December 2023. Demographic and clinical variables were collected and analyzed using descriptive and comparative statistics to evaluate trends in primary risk factor for HIV. Our primary outcome measure was incident HIV diagnosis with a primary risk factor of injection drug use (IDU), men who have sex with men (MSM), or heterosexual contact. A secondary outcome examined was CD4 count at the time of diagnosis.Results
A total of 246 patients were newly diagnosed with HIV. Of these, 59% (n = 146) reported heterosexual contact as their most likely cause of transmission, 19% (n = 47) MSM, 19% IDU (n = 46), and 3% (n = 7) reported both MSM and IDU. Heterosexual contact increased as the predominant HIV transmission factor from 53% (24/45) in 2019 to 79% (37/47) in 2023 (risk difference, 25%; 95% CI, 6.7%-44.1%), and the percentage of diagnoses made in non-US-born patients increased from 60% (27/45) in 2019 to 83% (39/47) in 2023 (risk difference, 23%; 95% CI, 5.1%-41%). Non-US born patients had significantly lower CD4 counts at diagnosis (mean [SD] CD4 count 299 [241] cells/μL) compared to US-born counterparts (mean [SD] CD4 count 498 [309] cells/μL, P < .001), with a mean difference of -199 cells/μL (95% CI, -272 to -125).Conclusion
The dominant risk factor for HIV transmission has changed from injection drug use/men who have sex with men to heterosexual contact in New England's largest city. Our findings associate increased HIV incidence in non-US-born immigrants at an urban essential hospital, highlighting the importance of considering this group in targeted public health efforts to avoid missing cases of HIV in similar settings.
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BibTeX
@article{frausto2026changing,
title = {{Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus.}},
author = {Sula Frausto and Heather Sperring and Glorimar Ruiz-Mercado and Cassandra Pierre and Kathryn Scrudder and Ijeoma Okafor and Kerrie Nelson and Elissa M Schechter-Perkins},
journal = {The western journal of emergency medicine},
year = {2026},
month = aug,
doi = {10.5811/westjem.52947},
url = {https://europepmc.org/article/MED/42900931},
note = {CC BY},
}
RIS
TY - JOUR
TI - Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus.
AU - Sula Frausto
AU - Heather Sperring
AU - Glorimar Ruiz-Mercado
AU - Cassandra Pierre
AU - Kathryn Scrudder
AU - Ijeoma Okafor
AU - Kerrie Nelson
AU - Elissa M Schechter-Perkins
PY - 2026
DA - 2026/08/26
JO - The western journal of emergency medicine
DO - 10.5811/westjem.52947
UR - https://europepmc.org/article/MED/42900931
AB - Introduction Since 2019, transmission risk factors among patients diagnosed with HIV have changed, although the trends and reasons behind them have not been fully elucidated. The objective of this study was to assess changes in HIV transmission risk factors among patients newly diagnosed with HIV to inform future targeted HIV testing programs.Methods This study site is New England's largest essential hospital and a major reporter of new HIV cases in Massachusetts. We performed a retrospective chart review of patients diagnosed with HIV infection at our medical center between January 2019 and December 2023. Demographic and clinical variables were collected and analyzed using descriptive and comparative statistics to evaluate trends in primary risk factor for HIV. Our primary outcome measure was incident HIV diagnosis with a primary risk factor of injection drug use (IDU), men who have sex with men (MSM), or heterosexual contact. A secondary outcome examined was CD4 count at the time of diagnosis.Results A total of 246 patients were newly diagnosed with HIV. Of these, 59% (n = 146) reported heterosexual contact as their most likely cause of transmission, 19% (n = 47) MSM, 19% IDU (n = 46), and 3% (n = 7) reported both MSM and IDU. Heterosexual contact increased as the predominant HIV transmission factor from 53% (24/45) in 2019 to 79% (37/47) in 2023 (risk difference, 25%; 95% CI, 6.7%-44.1%), and the percentage of diagnoses made in non-US-born patients increased from 60% (27/45) in 2019 to 83% (39/47) in 2023 (risk difference, 23%; 95% CI, 5.1%-41%). Non-US born patients had significantly lower CD4 counts at diagnosis (mean [SD] CD4 count 299 [241] cells/μL) compared to US-born counterparts (mean [SD] CD4 count 498 [309] cells/μL, P < .001), with a mean difference of -199 cells/μL (95% CI, -272 to -125).Conclusion The dominant risk factor for HIV transmission has changed from injection drug use/men who have sex with men to heterosexual contact in New England's largest city. Our findings associate increased HIV incidence in non-US-born immigrants at an urban essential hospital, highlighting the importance of considering this group in targeted public health efforts to avoid missing cases of HIV in similar settings.
SN - 1936-900X
SN - 1936-9018
ER -