In the United States, an estimated 1.2 million people are living with HIV infection, and each year, nearly 50,000 additional people become infected with the virus, according to a CDC Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) issued Nov. 28.
People living with HIV who use antiretroviral therapy (ART) and achieve very low levels of the virus (suppressed viral load) can have a nearly normal life expectancy and a very low risk for transmitting the infection to others. Completing each step along the HIV care continuum (HIV diagnosis, prompt and sustained HIV medical care, and ART) is essential for achieving a suppressed viral load, according to the report.
But just 30 percent of Americans infected with HIV had the virus under control in 2011, and about two-thirds of those whose virus was out of control had been diagnosed but were no longer in care. That's according to the CDC's November Vital Signs report, "HIV Care Saves Lives(www.cdc.gov)."
The MMWR article emphasized how important it is to make sure people with HIV infection receive ongoing care, treatment, and other information and tools to help them prevent transmission to others. The article also stressed the need to reach more people with HIV testing.
- A CDC Morbidity and Mortality Weekly Report issued Nov. 28 found that just 30 percent of Americans with HIV infection had the disease fully under control in 2011.
- The percentage of Americans infected with HIV who achieved viral suppression remained roughly stable (26 percent in 2009 versus 30 percent in 2011), the report said.
- The report also found that viral suppression increased with age, with young people significantly less likely than older age groups to have the virus under control.
"For people living with HIV, it's not just about knowing you're infected -- it's also about going to the doctor for medical care," said CDC Director Tom Frieden, M.D., M.P.H., in a Nov. 25 news release(www.cdc.gov). "And for health care facilities, it's not just about the patients in your care -- it's every person diagnosed, and every person whose diagnosis has not yet been made.
"Key to controlling the nation's HIV epidemic is helping people with HIV get connected to -- and stay in -- care and treatment, to suppress the virus, live longer and help protect others."
Overview of MMWR Findings
Data reported through December 2013 to the National HIV Surveillance System (NHSS) from all 50 states and the District of Columbia were used to estimate the number of people living with HIV infection and the number with diagnosed HIV by the end of 2011, according to the MMWR report. NHSS data from 19 jurisdictions (18 states and the District of Columbia) with complete laboratory reporting were used to estimate linkage to HIV medical care.
Findings showed that among the nearly 840,000 people who had not achieved viral suppression:
- 66 percent had been diagnosed but were not engaged in regular HIV care,
- 20 percent did not yet know they were infected,
- 4 percent were engaged in care but had not been prescribed antiretroviral treatment, and
- 10 percent had been prescribed antiretroviral treatment but had not achieved viral suppression.
The percentage of Americans with HIV infection who achieved viral suppression remained roughly stable (26 percent in 2009 versus 30 percent in 2011), the report said.
The study also found that viral suppression increased with age, with young people significantly less likely than older age groups to have their virus under control. Specifically, HIV suppression by age group was
- 13 percent among those ages 18-24,
- 23 percent among those ages 25-34,
- 27 percent among those ages 35-44,
- 34 percent among those ages 45-54,
- 36 percent among those ages 55-64, and
- 37 percent among those ages 65 and older.
The researchers attributed this disparity in large part to the fact that only 49 percent of those ages 18-24 who have HIV have been diagnosed, underscoring the need for more HIV testing in this population.
"It's alarming that fewer than half of HIV-positive young adults know they are infected," said Eugene McCray, M.D., director of the CDC's Division of HIV/AIDS Prevention, in the news release. "Closing that gap could have a huge impact on controlling HIV -- knowing your status is the first critical step toward taking care of your own health and avoiding transmission to others."
The study did not find statistically significant differences in viral suppression by race or ethnicity, sex or risk group.
CDC Offers Resources to Better Fight HIV Transmission
The CDC recommends physicians up their current efforts to fight HIV by focusing on diagnosis of the disease, following through with ongoing care and treatment, providing risk reduction information, and increasing reinforcement of medication adherence.
"There is untapped potential to drive down the epidemic through improved testing and treatment, but we're missing too many opportunities," said Jonathan Mermin, M.D., director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, in the news release. "Treatment is crucial. It is one of our most important strategies for stopping new HIV infections."
The CDC is currently backing initiatives to promote HIV testing and treatment that include innovative partnerships to make HIV testing simple, accessible and routine; programs to help health departments identify and reach out to infected individuals who have fallen out of care; and public awareness campaigns to urge testing and encourage people with HIV to seek ongoing care, according to the news release. These efforts are components of the National HIV/AIDS Strategy, which launched in 2010.
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