March 27, 2019 08:44 am News Staff – In a new Vital Signs report and accompanying early release Morbidity and Mortality Weekly Report (MMWR), the CDC said most new HIV infections seen in the United States in 2016 were transmitted by the nearly 40 percent of people who either did not know they had HIV infection or who had received a diagnosis but were not seeking care.
Published March 18, the first day of CDC's 2019 National HIV Prevention Conference, the reports offered the latest data on the impact of undiagnosed and untreated HIV infection in the country and underscore the critical need to expand HIV testing and treatment in the United States.
This need to get more people tested and into HIV care is key to the federal government's new initiative, Ending the HIV Epidemic -- A Plan for America.
The CDC said the initiative's goal is to stop the HIV epidemic in its tracks within 10 years by first focusing on the areas of the country with the greatest HIV burden before expanding efforts to all areas affected by HIV.
We have an unprecedented opportunity to end the HIV epidemic in America," said Admiral Brett Giroir, M.D., assistant secretary for health at HHS, in a press release. "We must close these glaring gaps in HIV prevention and care, and we must start now."
The CDC said its proposal to end the HIV epidemic is designed to rapidly reach the 48 U.S. counties with the highest HIV burden, as well as Washington, D.C.; San Juan, Puerto Rico; and seven states with a disproportionately rural HIV burden.
The goals of the effort are to reduce new HIV diagnoses by at least 75 percent in five years and 90 percent in 10 years, the agency said.
The initiative would begin with a proposed $291 million in HHS' fiscal year 2020 budget to provide the expertise, technology and resources required to address the HIV epidemic in the nation's hardest-hit communities, according to the news release.
"We have all the necessary tools to allow people with HIV to live longer, healthier lives, and to stop new infections," said CDC Director Robert Redfield, M.D., during a CDC press briefing on the topic. "But those tools will not help if people's HIV infections are not diagnosed or if they are unable to benefit from treatment. We must take advantage of these tools and we must apply them now to eliminate new HIV infection."
According to the MMWR, about 80 percent of new HIV transmissions in 2016 were linked to people whose HIV infection was either undiagnosed or currently untreated.
The overall estimated HIV transmission rate in 2016 was 3.5 new infections per 100 person-years; the rates of transmission decreased with progression along the HIV continuum of care.
Among estimated HIV transmissions in 2016:
Furthermore, the transmission rate was higher among younger people, with those ages 13 to 24 having the highest rates of transmission. However, because of overall population size and demographics, the CDC said people ages 55 and older were responsible for the largest percentage of new infections -- at 29.4 percent.
The CDC recommends that once patients with HIV learn their status, they begin taking antiretroviral therapy (ART). Medical treatment has substantially improved the health, quality of life and life expectancy of people with HIV infection.
"The benefits of treatment are maximized with suppression of the virus (less than 200 copies of HIV/mL of blood on the most recent viral load test), which benefits health and decreases rates of transmission," said the MMWR, pointing to four recent studies that showed viral suppression prevented sexual transmission of HIV.
"Together, these prospective studies found no HIV transmissions attributable to sex between HIV-discordant couples when the partner with HIV infection was on treatment and maintained viral suppression, despite documenting tens of thousands of acts of condom-less sex in which the HIV-negative partner was not using pre-exposure prophylaxis," said the report.
Fortunately, the MMWR noted, "Today's treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects; most persons with HIV infection can achieve viral suppression within six months of initiating treatment."
"Today, we have the tools to end the HIV epidemic," said Jonathan Mermin, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, in the release. "But a tool is only useful if it's in someone's hands. This is why it's vital to bring testing and treatment to everyone with HIV -- and to empower them to take control of their lives and change the course of the epidemic."
To that end, the CDC provides resources for physicians to support their efforts to diagnose and care for patients with HIV, including information on ART initiation, adherence and viral suppression; viral load monitoring; ongoing care; the patient-physician relationship and potential coinfections.
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