People unaware of their HIV status account for about 40 percent of ongoing transmission of the virus in the United States. According to one family physician expert, these cases, in particular, represent missed opportunities to improve health outcomes and prevent spread of the infection.
However, a new CDC Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) and related Vital Signs report(www.cdc.gov) are offering some encouraging news: HIV is being diagnosed sooner after infection than had previously been reported.
According to the MMWR, the estimated median time from HIV infection to diagnosis was three years in 2015 -- an improvement from 2011, when the interval was three years, seven months.
This seven-month improvement represents a considerable decrease during that four-year period, said the CDC, and reinforces other recent signs that the national approach to HIV prevention appears to be paying off.
Overall, 85 percent of the estimated 1.1 million U.S. residents living with HIV in 2014 knew their HIV status.
- A new CDC Morbidity and Mortality Weekly Report (MMWR) and related Vital Signs said HIV is being diagnosed sooner after infection than had previously been reported.
- According to the MMWR, the estimated median time from HIV infection to diagnosis was three years in 2015 -- an improvement from 2011, when the median interval was three years, seven months.
- Increasing the use of opt-out HIV testing and eliminating the stigma surrounding HIV infection are key to fighting the infection, says one FP expert.
"These findings are more encouraging signs that the tide continues to turn on our nation's HIV epidemic," said CDC Director Brenda Fitzgerald, M.D., in a news release.(www.cdc.gov) "HIV is being diagnosed more quickly, the number of people who have the virus under control is up,(www.cdc.gov) and annual infections are down.(www.cdc.gov) So while we celebrate our progress, we pledge to work together to end this epidemic forever."
Family Physician Expert's Take
AAFP Director Ada Stewart, M.D., of Columbia, S.C., told AAFP News her practice has seen great results from implementing free opt-out HIV testing.
"Everyone seen in our practice is offered free testing for HIV at intake," she said. "If someone declines testing at time of intake, I try to persuade them again when I see them in the exam room."
Stewart said nationally, opt-out HIV testing has expanded the number of patients tested, but there still is progress to be made.
And although the AAFP, CDC and U.S. Preventive Services Task Force recommend using opt-out testing for HIV, many family physicians don't offer the option because of time constraints, she said.
"In addition, many of my colleagues have said they feel uncomfortable taking a detailed sexual history or dealing with positive results," Stewart noted. She contends that these issues can be addressed through better HIV education in medical school and residency.
"I have students whom I precept who are shocked when they see the variety (old, young, white, black, men having sex with men (MSM), married heterosexuals, etc.) of HIV-positive individuals," she said.
For example, Stewart said she's recently seen an uptick in cases of HIV infection in her heterosexual African-American female patients.
Furthermore, there's still a stigma that patients attach to HIV, said Stewart. To counteract this, she said family physicians need to keep educating patients about the disease and about testing, including the fact that there are OTC home tests available now.
Another important step in combating HIV infection is offering pre-exposure prophylaxis (PrEP) to patients if their sexual histories show they are at risk for HIV exposure. Additionally, Stewart said she and her staff work with other health care professionals and advocates in the community to support efforts to reduce HIV cases.
"We also are now offering transgender services -- a population that is at increased risk for HIV," she said.
Additional CDC Report Details
Data from the CDC's National HIV Surveillance System were used to estimate, among people diagnosed with HIV infection in 2015, the median interval from infection to diagnosis (diagnosis delay). Specifically, the first CD4 test result after HIV diagnosis and a CD4 depletion model indicating disease progression were used to estimate year of infection and the distribution of time from HIV infection to diagnosis among people with diagnosed infection. The distribution of diagnosis delay was used to estimate the annual number of HIV infections, including people with diagnosed infection and those with undiagnosed infection.
These data were also analyzed to determine the percentage of people at increased risk for HIV infection who had been tested in the past 12 months and the percentage of those who had missed opportunities for testing.
The CDC's analysis showed the percentage of people at increased risk for HIV who reported getting an HIV test the previous year has increased.
Among people interviewed through the National HIV Behavioral Surveillance, 71 percent of MSM, 58 percent of people who inject drugs and 41 percent of heterosexual people at increased risk for HIV infection reported testing in the past 12 months.
However, in each risk group, at least two-thirds of the people who didn't have an HIV test had seen a health care professional in the past year.
Quick testing and diagnosis of HIV are important, said the CDC, because people who are living with undiagnosed HIV may do so for many years. One in four individuals diagnosed with HIV in 2015 lived with the disease for seven or more years without knowing it.
The researchers also found that the estimated timing from HIV infection to diagnosis varied by risk group and race/ethnicity.
For example, estimated timing from HIV infection to diagnosis ranged from a median of five years for heterosexual males to two-and-a-half years for heterosexual females and females who inject drugs. The median was three years for gay and bisexual males. Estimated timing from infection to diagnosis ranged from a median of four years for Asian-Americans to two years for white Americans and about three years for African-Americans and Latinos.
The CDC's recommendation for HIV testing(www.cdc.gov) is to test all patients ages 13-64 for the virus at least once in their lifetime, and people at higher risk for the disease at least once a year.
The agency said health care professionals might consider testing sexually active gay and bisexual men more frequently (e.g., every three to six months).
CDC funding supports more than 3 million HIV tests nationally each year, which identify, on average, more than 12,000 people with previously undiagnosed HIV infection. This accounts for one-third of all HIV diagnoses annually in the United States.
Stewart concluded that because family physicians conduct one in every five office visits that occur each year, the opportunity exists for them to really make a difference in the fight against HIV infection.
"We have to increase use of opt-out HIV testing," she said. "Too many individuals have been seen by providers who missed opportunities. We have to continue to address the stigma -- I tell my patients, 'If you have had sex, you are at risk, and other risk factors include drug use.' And we have to continue to educate our patients regarding prevention -- if they're at risk, then recommend the use of PrEP.
"The study shows that although we are seeing progress, we still have a long way to go to end this epidemic."
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