Too many Americans are unaware they have HIV, and when they know, they aren't treating it correctly.
That's according to a CDC Morbidity and Mortality Weekly Report(www.cdc.gov) posted online Dec. 3 as an MMWR Early Release that noted progress in reducing new HIV infections in the United States has stalled in recent years.
The agency said increasing HIV testing, treatment and preexposure prophylaxis are all integrally important to curbing HIV transmission and preventing some 38,000 new cases each year.
Additionally, the CDC said health disparities must be addressed to stop HIV transmission, which is part of HHS' initiative Ending the HIV Epidemic: A Plan for America(www.cdc.gov) that aims to reduce HIV infections by 90% by 2030.
"The time is now to end HIV in America," said CDC Director Robert Redfield, M.D., in a news release.(www.cdc.gov) "We have the right tools, the right data and the right leadership to get this done. Those living with HIV are our best teachers. They are key to helping us reach people where they are so that we can better diagnose and link patients to care."
- Too many Americans are unaware they have HIV infection, and when they know, they aren't treating it correctly, says a new CDC report.
- According to the report, about 154,000 people with HIV infection (14%) in 2017 were unaware of their status and therefore, could not take advantage of HIV treatment to stay healthy, control the virus and avoid transmitting the infection to others.
- A study published last month in JAMA Internal Medicine found that distributing HIV self-tests increased awareness and prevented transmission of HIV infection among men who have sex with men.
CDC Report Findings
To better focus efforts to meet this lofty goal, CDC researchers analyzed surveillance, pharmacy and other data to determine current status in diagnosing, treating and preventing HIV infection. First, the agency analyzed data reported to the National HIV Surveillance System for people ages 13 and older with diagnosed HIV infection from the beginning of the epidemic in the early 1980s through June 2019 from 50 states and the District of Columbia.
From that data, the researchers estimated the annual number of new HIV infections from 2013 to 2017, the total number of people living with HIV infection (diagnosed and undiagnosed) at the end of 2017, and the percentage of people with HIV infection who had received a diagnosis.
NHSS data reported from 41 states and the District of Columbia that had complete laboratory reporting of viral load test results was used to determine two viral suppression measures: viral suppression among people with diagnosed HIV infection in each of these 42 jurisdictions at the end of 2017 and viral suppression within six months of diagnosis among persons with HIV infection diagnosed during 2017.
Overall, these 42 jurisdictions accounted for 89% of people with diagnosed HIV infection in the United States.
The agency also analyzed data from the IQVIA Real World Data-Longitudinal Prescriptions database to estimate the number of people ages 16 and older who were prescribed PrEP in 2017 and 2018. Next, NHSS, National Health and Nutrition Examination Survey and U.S. Census data were used to estimate the number of people in that age group who had indications for PrEP. Finally, PrEP coverage was calculated as the number of people who were prescribed PrEP divided by the estimated number of people with indications for PrEP and reported as a percentage.
According to the report, about 154,000 people with HIV infection (14%) in 2017 were unaware of their status and, therefore, could not take advantage of HIV treatment to stay healthy, control the virus and prevent transmission of the virus to others. Notably, young people ages 13-24 were less likely than those 25 and older to know their HIV status.
Only 63% of those who knew they had HIV infection in 2017 had the virus under control through effective treatment; young people and African Americans were least likely to have the virus under control.
As for PrEP use in 2018, the CDC said only about 18% of the 1.2 million people who could benefit from the medication had received a prescription for it. PrEP coverage was particularly low among young people, African Americans and Latinos.
It's worth noting that the analysis was able to capture data from 92% of all prescriptions from U.S. retail pharmacies but not from closed health care systems such as managed care organizations or military health plans. Therefore, PrEP coverage was likely higher than these estimates.
In related news, a study published last month(jamanetwork.com) in JAMA Internal Medicine found that distributing HIV self-tests increased awareness and prevented transmission of HIV infection among men who have sex with men.
For this randomized clinical trial, 2,665 U.S. participants were recruited from March through August 2015. Recruits were at least 18, reported having had anal sex with men in the past year and had never tested positive for HIV infection.
Participants completed quarterly online surveys for a year, and telephone call notes and laboratory test results also were included in the analysis, which was conducted from August 2017 through December 2018.
Organizations Protest Misinformation on PrEP
In a Dec. 9 open letter to Facebook,(www.glaad.org) a diverse group of organizations focused on LGBTQ advocacy, public health and HIV/AIDS prevention urged Facebook and Instagram (which Facebook owns) to remove ads targeting LGBTQ users that presented false information on negative health effects of pre-exposure prophylaxis using Truvada.
The groups say that various law firms are using these targeted ads to try to recruit gay and bisexual men who use Truvada as PrEP to join a lawsuit claiming that the drug has caused harmful side effects, specifically bone density and kidney issues.
"By focusing on 'Truvada' and PrEP -- rather than 'Tenofovir Disoproxil Fumarate' and HIV-positive individuals who use it as an antiviral -- the law firms' advertisements are scaring away at-risk HIV-negative people from the leading drug that blocks HIV infections," the letter stated. "This is despite numerous studies underscoring the safety of TDF in HIV-negative PrEP users."
All participants completed baseline surveys, as well as additional surveys at three, six, nine and 12 months, and all were given access to AIDSVu.org,(aidsvu.org) an interactive online mapping tool that visualizes the impact of HIV infection across the country and provides prevention information and resources to locate local HIV testing services. Ongoing HIV counseling was also available to all participants.
After completing the baseline survey, participants in the intervention arm were mailed two oral fluid HIV self-tests and two finger-stick whole blood HIV self-tests. Then, after completing interim surveys at three, six and nine months, these participants could order HIV self-tests to replace tests used or given away.
After completing the survey at the end of the trial or after reporting a positive HIV result during the trial, both intervention and control participants were offered one dried blood stain kit and one of each HIV self-test.
What the researchers found was that more MSM participants in the arm that was mailed HIV self-tests reported testing for HIV three or more times during the trial compared with control participants, with 12 infections identified in the self-testing arm in the first three months compared with two infections in the control arm.
Participants who said they shared the study's self-tests reported that those tests detected 34 infections among their social network members.
Ending the HIV Epidemic
If funded at the $291 million level requested, the administration's Ending the HIV Epidemic initiative expects to provide resources, technology and expertise in areas hit hardest by HIV.
The CDC reports that more than half of newly diagnosed HIV cases occurred in just 48 U.S. counties; San Juan, Puerto Rico; and Washington, D.C., and the agency pointed to seven states that bear a substantial rural burden. That's where the initiative plans to first focus its efforts.
If additional support becomes available, the CDC plans to expand its initiative nationally by scaling up four science-based strategies to help end the epidemic. They are
- diagnose all patients with HIV infection as early as possible, with a target of diagnosing at least 95% of HIV infections;
- treat those who are infected rapidly and effectively to reach sustained viral suppression, with a target of at least 95% of people with diagnosed HIV reaching viral suppression;
- prevent new HIV transmissions by using proven interventions, including PrEP and syringe services programs; for PrEP, the target is for at least 50% of those who could benefit from it to receive a prescription; and
- respond quickly to HIV outbreaks to get needed prevention and treatment services to people who need them.
Related AAFP News Coverage
Newly Released Tools Support HHS Plan to End HIV Epidemic
AAFP Updates HIV-related Recommendations