Only about 28% of the nearly 1.2 million people infected with HIV in the United States are receiving appropriate treatment and have a suppressed viral load, according to a new report released Nov. 29 by the Centers for Disease Control and Prevention.
The report’s findings signal the need for greater effort in increasing HIV testing and in keeping infected people linked to treatment, which will also have an impact on preventing transmission, Dr. Thomas R. Frieden, director of the CDC, said during a telebriefing held the same day.
Copyright Dr. A. Harrison; Dr. P. Feorino / CDC
One in five people infected with HIV is unaware of his or her status, which accounts for an estimated 240,000 people in the United States.
There are many missed opportunities for patients to be treated properly and to be counseled about prevention, Dr. Frieden said, noting that only about half of the people who are aware they have HIV remain in treatment. These gaps require "all of us to be more accountable," including health care professionals who can offer HIV testing as a regular part of medical care, as well as ongoing treatment and prevention counseling after diagnosis.
Dr. Frieden referred to the encouraging results of the recent National Institutes of Health study of heterosexual couples, which found that consistently taking antiretroviral therapy (ART) can reduce the risk of transmission to the uninfected partner by about 96%.
HIV testing is the "gateway to effective treatment and prevention," Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the CDC, said during the briefing. But one in five people infected with HIV is unaware of his or her status, which accounts for an estimated 240,000 people in the United States, he added.*
These figures are from the Vital Signs report on "HIV Prevention Through Care and Treatment – United States," (MMWR 2011;60:1-6). The results highlight the challenges in getting patients with HIV diagnosed, into care, and controlling HIV "in themselves and their communities," Dr. Frieden pointed out.
The CDC report used different surveillance data sets and published data to provide estimates that included how many HIV-infected people in the United States receive treatment and the proportion of people with HIV who have a suppressed viral load:
• Of the estimated 1.2 million people infected with HIV in the United States in 2008, 80% had been diagnosed.
• In 2010, 9.6% of adults aged 18-64 years had been tested for HIV during the previous 12 months, ranging from 4.9% to 29.8% in different states, with higher rates in those states with a higher prevalence of HIV.
• About 77% of the people diagnosed with HIV are linked to care within 3-4 months, and 51% remained in ongoing care.
• Of the adults who were receiving care for HIV, 89% had been prescribed ART; of these people, 77% had a suppressed viral load, based on their most recent test. (A suppressed viral load is associated with reduced morbidity and mortality and a lower risk of HIV transmission to sexual partners.)
Based on these data, an estimated 28% of the 1,178,350 people infected with HIV in the United States have a suppressed viral load, according to the report.
The proportion of patients who had been prescribed ART, had achieved viral suppression, and had received prevention counseling from a health care provider during the previous year differed by age, race, and ethnicity, and reported sexual behavior. For example, 76% of those aged 18-24 years had received ART, compared with 92% of those aged 55 years and older. ART was prescribed to 92% of whites, 89% of Hispanics, and 86% of blacks, with viral suppression rates of 84%, 79%, and 70%, respectively.
A higher proportion of men who have sex with women received only a prescription for ART (91%), compared with men who have sex with men (89%) and women who have sex with men (86%). Viral suppression rates were higher among men (81% of men who have sex with men and 75% of men who have sex with women), compared with women who have sex with men (71%).
Although 77% of people were linked to care after being diagnosed with HIV infection, "more effort is needed to ensure that those patients remain in care and to eliminate disparities among subgroups who are prescribed ART and subsequently achieve viral suppression," the report concluded. The report pointed out that less than half of the patients with HIV in one of the data sets had received counseling about prevention in the previous year, especially among men who have sex with men, which indicates "a need for health-care providers to deliver HIV prevention services more consistently."