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EPIDEMIOLOGY REPORT WASHINGTON STATE U SEATTLE & KING COUNTY Page a
Washington State / Seattle-King County HIV/AIDS Epidemiology Report This 85th edition of the HIV/AIDS Epidemiology Report includes data available through the end of June 2016. This report is produced jointly by Public Health – Seattle & King County and the Infectious Disease Assessment Unit, Washington State Department of Health. It is funded partly by a Centers for Disease Control and Prevention cooperative agreement for HIV/AIDS surveillance. We thank the medical providers caring for people with HIV/ AIDS and the clinics and patients participating in epidemiologic projects. Their cooperation with public health department HIV/AIDS control efforts permits the collection of data included in this report – data which are used for further prevention and planning efforts. We also wish to acknowledge the outstanding assistance of our staff, including Edith Allen, Winnie Alston, Chelsey Kassa, Christy Johnson, Lexa Moongrace, Allison Moore, Rachel Patrick, Shana Patterson, Michelle Perry, and Ariel VanZandt (disease investigation); Sandy Hitchcock (data entry and quality assurance); Leslie Pringle, Luke Syphard, and Shirley Zhang (data management); Jocelyn Castillo (graphics assistance); Teal Bell, Amy Bennett, Richard Burt, Jason Carr, Katelynne Gardner Toren, Julia Hood, Amanda Jones, Claire LaSee, Weiyi Li, Jen Reuer and Christina Thibault (epidemiologists); Julie Dombrowski, Lindley Barbee, David Katz, and Amanda Jones (peer reviewers); and especially Bill Johnson for desktop publishing this report.
HIV/AIDS Epidemiology Report Co-Editors: HIV/AIDS Epidemiology Program
Infectious Disease Assessment Unit
Susan Buskin, PhD, MPH, Senior Epidemiologist, PHSKC HIV/AIDS Epidemiology
Tom Jaenicke, MPH, MBA, MES Section Manager/Senior Epidemiologist Washington State Department of Health PO Box 47838, Olympia, WA 98504-7838
Sara Glick, PhD, MPH, Senior Research Scientist, 401 5th Avenue, Suite 1250, Seattle, WA 98104
Contributors to this Issue Washington State Department of Health
University of Washington
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Public Health – Seattle & King County
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Cover photo: Lisa Sokanoff
HIV/AIDS Epidemiology Report 201
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HIV/AIDS Reporting Requirements Detailed requirements for reporting of communicable diseases including HIV/AIDS are described in the Washington Administrative Code (WAC), section 246-101 (http://apps.leg.wa.gov/WAC/default.aspx?cite=246-101). Washington health care providers are required to report all HIV infections, regardless of the date of the patient’s initial diagnosis, to the health department. Providers are also required to report new diagnoses of AIDS in a person SUHYLRXVO\GLDJQRVHGZLWK+,9LQIHFWLRQ/RFDOKHDOWKGHSDUWPHQWRI¿FLDOVIRUZDUGFDVHUHSRUWVWRWKH'HSDUWPHQWRI Health. Names are never sent to the federal government. Laboratories are required to report evidence of HIV infection (i.e., positive western blot assays, p24 antigen detection, viral culture, and nucleic acid detection), all HIV viral load tests (detectable or not), and all CD4 counts in the setting of HIV infection. If the laboratory cannot distinguish tests, such as CD4 counts, done due to HIV versus other diseases (such as cancer), the CD4 counts should be reported and the health department will investigate. However, laboratory reporting does not relieve health care providers of their duty to report, as most of the critical information necessary for surveillance and follow-up is not available to laboratories. HIV reporting details: HIV and AIDS are reportable to the local health department within three working days. Case report forms are available online (http://www.doh.wa.gov/portals/1/Documents/5000/hiv-case-report.pdf) or by calling 888-367-5555 (State) or 206-263-2000 (King County). We also appreciate reports of deaths and diagnoses of SRWHQWLDOSXEOLFKHDOWKVLJQL¿FDQFHVXFKDVXQXVXDOVWUDLQV )RUIXUWKHULQIRUPDWLRQDERXW+,9$,'6UHSRUWLQJUHTXLUHPHQWVSOHDVHFDOO\RXUORFDOKHDOWKGHSDUWPHQWRUWKH Washington State Department of Health at 888-367-5555. In King County, call 206-263-2000.
Suggested citation: HIV/AIDS Epidemiology Unit, Public Health – Seattle & King County and the Infectious Disease Assessment Unit, Washington State Department of Health. HIV/AIDS Epidemiology Report 2016, Volume 85.
HIV/AIDS Epidemiology publications are online at: www.kingcounty.gov/healthservices/health/communicable/hiv/epi.aspx
Alternative formats provided upon request. To be included on the mailing list or for address corrections, please call 206-263-2000 or email
[email protected].
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Contents 'H¿QLWLRQViv Executive Summary................................................1 PHSKC HIV/STD Program HIV Goals and Evaluation Metrics (Dashboard)...................................................2 HIV/AIDS Data in King County Table 1. People Living with HIV Disease as of December 31, 2015 by Residence Status, King County................................................................4 Table 2. New HIV Cases, King County, 2010-2015..........5 7DEOH1HZ+,9&DVHVE\)RUHLJQ%RUQ6WDWXV and Other Select Characteristics, King County, 2011-2015..................................................................6 )LJXUH.LQJ&RXQW\+,9'LDJQRVHV$,'6 'LDJQRVHV'eaths, and 3eople /iving with 'iagnosed +,95DWHV2002-2015.................................................7 Table 4. AIDS Cases and Cumulative Deaths, King County................................................................8 Table 5. People Living with HIV Disease as of December 31, 2015, King County.................................9 Table 6. Living HIV Cases by Exposure Category, Sex Assigned at Birth and Race/Ethnicity as of December 31, 2015, King County...............................10 Table 7. HIV among Men Who Have Sex with Men and All HIV Cases, King County..................................11 Table 8. HIV among People That Identify as Transgender and All HIV Cases, King County...............12 Table 9. Characteristics and HIV Prevalence among Participants in Seattle-area National HIV Behavioral Surveys, 2013-2015..................................................13 HIV/AIDS Data in Washington State Table 10. New HIV Cases, Washington State, 2010-2015...............................................................14 Table 11. New HIV Cases by County and Combined Local Health District (HD), 2010-2015........................15
)LJXUH:DVKLQJWRQ6WDWH+,9'LDJQRVHV$,'6 Diagnoses, Deaths, and People Living with Diagnosed HIV rates, 2006-2015...............................17 Table 13. AIDS Cases and Cumulative Deaths from HIV or AIDS, Washington State..................................18 Table 14. People Living with HIV Disease as of December 31, 2015, Washington State.......................19 Table 15. People Living with HIV by Exposure Category, Sex Assigned at Birth, and Race/Ethnicity as of December 31, 2015, Washington.......................20 )LJXUH:DVKLQJWRQ6WDWH+,9&DUH Continuum, as of June 30, 2015................................21 HIV/AIDS Epidemiology and Surveillance News HIV Rates, Trends, and Burden of Disease in Washington State.....................................................22 HIV Co-Morbidities in Washington State.....................27 Monitoring the Goals of the National Strategy for HIV/AIDS and the King County HIV Care Continuum........................................................32 2016 Seattle Pride Survey..........................................46 Highlights from the 2015 Seattle Area National HIV Behavioral Surveillance Survey of Injection Drug Use.................................................................51 Behavioral and Clinical Characteristics of Patients Receiving HIV Care in King County: Medical Monitoring Project, in 2013-2014...................59 2016 Survey of Provider Experiences with PrEP (Pre-Exposure Prophylaxis) in King County, Washington.............................................................64 Surveillance Investigations of emtricitabine/ tenofovir PrEP Resistance in King County, Washington.............................................................70 Transitions in Acute HIV Research..............................72 AIDS Clinical Trials Unit Current Studies......................73 Other Clinical Trials...................................................78
7DEOH1HZ+,9&DVHVE\)RUHLJQ%RUQ6WDWXV and Other Select Characteristics, Washington State, 2011-2015...............................................................16
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'H¿QLWLRQV AIDS:$FTXLUHG,PPXQH'H¿FLHQF\6\QGURPH7KLVLV WKHDGYDQFHGVWDJHRI+,9LQIHFWLRQDQGLVGH¿QHGE\D VSHFL¿FLPPXQHV\VWHPGH¿FLHQF\LQ&'O\PSKRF\WH FHOOV SHU/ DQGRUWKHGLDJQRVLVRIVSHFL¿F opportunistic illnesses. In the absence of antiretroviral therapy, AIDS had a median onset of about 8-10 years after HIV infection.
CDC: Centers for Disease Control and Prevention. CD4 Count:7KHQXPEHURIDVSHFL¿FW\SHRIZKLWH blood cell, also called T-helper cells. The CD4 count is measured per μL (also called mm3 – a very small drop equivalent to 2 ten-thousandths of a teaspoon) of plasma or blood. CD4 count provides a good indication of a patient’s stage of HIV illness. CD4 counts between 500 and 1,500 indicate normal immune function, CD4
