The changing epidemiology of HIV/AIDS at a Minnesota hospital: Impact of demographic change and viral diversity

Abstract

The past decade has seen a dramatic influx of African-born immigrants and refugees into Minnesota. The impact of this on Hennepin County Medical Center (HCMC), a public teaching hospital located in Minneapolis, has been considerable, especially in the management of HIV-infected persons given that approximately 30% of newly diagnosed individuals seen at HCMC in the past 3 years acquired the virus in Africa. An ongoing and permanent alteration in the demographics of HIV/AIDS in this part of the American midwest is clearly occurring, therefore, accompanied by considerable diversification of the viral makeup of the epidemic. The following article describes currently available data on the viral characteristics of the African-born HIV-infected population of Minnesota and highlights the potential impact of this expanding viral diversity on the ability of the clinical laboratory at HCMC to provide the virologic information necessary to manage effectively patients infected with the HIV virus.

Large-Scale Analysis of the Prevalence and Geographic Distribution of HIV-1 Non-B Variants in the United States

“…The utility of resistance genotyping sequences for HIV-1 characterization has been established by numerous studies (23,26,(34)(35)(36)(37)(46)(47)(48)(49). Current U.S. guidelines recommend resistance genotype testing at the initiation of antiretroviral therapy and for subsequent patient monitoring (50).…”

“…There is evidence of increasing non-B prevalence in the United States, and it may be higher than generally recognized (29,(32)(33)(34). Although data are limited, studies have shown that the prevalence of non-subtype B varies greatly depending on the population analyzed, ranging from 0.6% in a northern California clinic-based setting (35) to 95% in African-born immigrants in Minneapolis, MN (28,36), and New York City (27). The largest published population-based study to date was performed by the Centers for Disease Control and Prevention.…”

Review of status of HIV strain diversity in the United States

“…Recently published results of a targeted HIV surveillance of the African-born, HIV-infected patients attending the HIV clinic at the Hennepin County Medical Center, Minneapolis, MN, are quite dramatic [Hirigoyen and Cartwright, 2005;Sides et al, 2005;Cartwright, 2006]. The majority (95%) of African-born patients, who make up 10% of the clinic patients, were infected with non-B strains.…”

Correlates of Condom Use Among Somali and Ethiopian Immigrants in the U.S.

“…Among African-born persons newly diagnosed with HIV at Hennepin County Medical Center (Minneapolis), it was estimated 70 % acquired the virus in the U.S. [12].…”

“…Although, it is difficult to quantify the percentage of new HIV infections occurring among African-born persons in the U.S. as compared to those who acquired the infection outside the U.S., [3], many cases of HIV infections among African-born persons are thought to have been in their native countries [5]; nonetheless, many immigrants are also being infected in the U.S. [2,12]. Among African-born persons newly diagnosed with HIV at Hennepin County Medical Center (Minneapolis), it was estimated 70 % acquired the virus in the U.S. [12].…”