Test specificity by time to expiration.

<p>Test specificity by time to expiration.</p

Regression standardized test specificity by month to expiration, adjusting for site, lot, and technician.

<p>The blue squares in the figure represent the mean adjusted specificity of the tests, and the black ovals represent the limits of the 95% bootstrap confidence interval.</p

Multivariable logistic model for false positive test results.

<p>Multivariable logistic model for false positive test results.</p

Total CVL and Virologic Suppression, 2004–2008.

<p>There was a statistically significant decline in annual measures of total CVL from 2004–2008 (p = 0.021). As expected, there was an inverse correlation between the increase in virologic suppression (red line) from 45% in 2004 to 78% in 2008 (p = 0.006) and total CVL (p = 0.011).</p

Characteristics of HIV-positive persons and mean community viral load (CVL), San Francisco, 2005–2008.

1<p>Other race includes Asian, Pacific Islander, Native American, Mixed race, Other, and Unknown.</p>2<p>Other risk includes sex with female, hemophilia, blood transfusion, heterosexual relations, transplant, occupational, and no identified risk.</p>3<p>Other/Unknown insurance includes VA, Healthy San Francisco, San Francisco Jail, and unknown insurance status.</p

Spatial Distribution of CVL by Neighborhood, 2005–2008.

<p>Neighborhood mean (1a) and total CVL (1b) are shown. Mean CVL was highest among homeless individuals (38,974copies/mL; N = 775; 6%). The highest mean CVL (38,428 copies/mL; N = 278; 2%) was in the southeast neighborhood of Bayview, which is characterized by lower income and a predominantly African-American population. The northeast and inner city areas of the Tenderloin and South of Market (characterized by low income and large numbers of IDU, commercial sex workers, and transgendered persons) also had a mean CVL above the municipal average (28,093 copies/mL; N = 1,486; 12%). The Castro neighborhood (an historic gay and relatively upper-income neighborhood with very high HIV/AIDS case density) had a mean CVL of 21,352 copies/mL (N = 2,106; 17%), below the city as a whole. The distinction between mean CVL and total CVL is seen in 1b. The highest total CVLs are evident in the Tenderloin, South of Market, Mission, and the Castro, where there are either large numbers of persons living with HIV, many persons with high VLs, or a combination thereof.</p

Mean CVL and New HIV Infections, 2004–2008.

<p>There was a statistically significant decline in annual measures of mean CVL from 2004–2008 (p = 0.037). Newly diagnosed cases of HIV (shown in red with ) decreased in San Francisco from 798 (2004) to 434 (2008) (p<0.005). The point estimates of HIV incidence (shown in dark red with ▵) using the CDC methods also declined from 935 [95% CI 658–1212] in 2006, to 792 [552–1033] in 2007 and 621 [462–781] in 2008, although the change was not statistically significant (trend p = 0.29). The reductions in annual measures of mean CVL were significantly associated with decreases in newly diagnosed and reported HIV cases from 2004–2008 (p = 0.003). Longitudinal reductions in estimated HIV incidence were consistent with the trends in mean and total CVL, but the association in the meta-regression was not statistically significant (p>0.3).</p

Performance of models selected during the development stage (using recent infection as the outcome), here validated using acute HIV infection cases as the outcome.

<p> <b>All models are based on acute HIV infection among persons undergoing HIV testing at the San Francisco City Clinic from 2004–2007 (validation data; n = 12252; excludes recent and longstanding infections).</b></p>1<p><b>Key to checklists:</b> MSM (person is a man who had sex with male partner(s)); IDU (any history of injection drug use); +partner (person had a partner known to be HIV positive); uRAI (engaged in unprotected receptive anal intercourse); STI (had a sexually transmitted infection within the past 2 years or since the last HIV test); AI (engaged in any anal intercourse, regardless of sex or gender); uAI (engaged in unprotected anal intercourse, regardless of sex or gender); RAI (engaged in receptive anal intercourse, regardless of sex or gender); uRAI (engaged in unprotected receptive anal intercourse, regardless of sex or gender).</p

Characteristics, prevalence of longstanding and recent HIV infection, and associations with recent HIV infection among persons undergoing HIV testing at the San Francisco City Clinic from 2004–2007 (development data; n = 12622).

1<p>Longstanding HIV prevalence: prevalence of longstanding infection over the entire study period (2004–2007) (note: recent and acute infections were excluded from the denominator).</p>2<p>Recent HIV prevalence: prevalence of recent infection over the entire study period (2004–2007) (note: acute and longstanding infections were excluded from the denominator).</p>3<p>Age, median (IQR): 32 yrs (26–39).</p>4<p>GLBQQ/Other group includes gay, lesbian, bisexual, queer, “don't know” (questioning), and “other”.</p>5<p>All risk behaviors occurring since time of last HIV test or within the past 2 years, whichever is shorter.</p>6<p>Sexually transmitted infection diagnosed since time of last HIV test or within the past 2 years, whichever is shorter.</p

Performance of various HIV assays with respect to rise and fall of CD4 count, HIV antibodies, HIV viral load, and viral shedding over time after infection.

<p>Black bars to the left of assay names indicate ability of that assay to detect HIV infection.</p