An estimated 50,000 people are infected with HIV every year in the United States, despite successful efforts to prevent HIV infections and a marked drop in deaths since the epidemic began 30 years ago, according to a report from the Centers for Disease Control and Prevention.
Moreover, about 20% of people infected with HIV are undiagnosed, according to the report on HIV surveillance in the United States between 1981 and 2008, which appeared in the June 3 issue of Morbidity and Mortality Weekly Report (MMWR 2011;60:689-93).
The report summarizes the findings of the CDC’s analysis of data from the National HIV Surveillance System of HIV and AIDS cases in people aged 13 years and older, between 1981, the beginning of the AIDS epidemic, and 2008.
The estimated number of people aged 13 years and older newly diagnosed with AIDS every year rapidly increased from 1981 to 1992, from 318 in 1981, peaking at 75,457 in 1992. The estimated number of AIDS-related deaths also increased, from 451 in 1981, peaking at 50,628 in 1995.
This was followed by a marked drop in AIDS diagnoses and deaths from 1995 to 1998, after highly-active antiretroviral drugs became available, and in 1999, the number of new cases and deaths started to stabilize. Between 1999 and 2008, there was an average of 38,279 diagnoses and 17,489 deaths per year. In addition, the estimated number of people aged 13 years and older who were living with AIDS increased from 219,318 in 1996 to 479,161 in 2008, more than a twofold increase.
Still, the report pointed out, an estimated 1,178,350 people at the end of 2008 were living with HIV, about 20% of whom were undiagnosed. These findings "underscore the importance of the national HIV/AIDS Strategy focus on reducing HIV risk behaviors, increasing opportunities for routine testing and enhancing use of care." Of those living with HIV at the end of 2008, 75% were men; of the men, almost 66% were men who have sex with men.
The report also finds disparities between races and ethnic groups: The prevalence of HIV was about eightfold higher among blacks and about 2.5 times higher among Hispanics than among whites. And Asians or Pacific Islanders, and American Indians or Alaska natives accounted for a higher proportion of those with undiagnosed HIV infections (as did men with high-risk heterosexual contacts) than among blacks, whites, or Hispanics.
An editorial note accompanying the report points out that HIV prevention efforts have prevented an estimated 350,000 HIV infections during 1991-2006, at a savings of $125 billion in medical costs.
More than half of the estimated 50,000 people who are infected every year in the United States are men who have sex with men, and almost half are black.
But the proportion of men who have sex with men who are diagnosed with HIV continues to increase, and has increased steadily since the early 1990s, and late diagnoses of HIV are common, according to the editorial note. Of the newly diagnosed HIV cases in 2008, 33% were diagnosed with AIDS within 1 year of the HIV diagnosis, and were "likely" infected an average of 10 years before being diagnosed – during which time, "they missed opportunities to obtain medical care and to prevent unwitting transmission of HIV to others," the editorial noted.
The report and editorial note ends by pointing out that the National HIV/AIDS Strategy is refocusing efforts to increase HIV prevention efforts in communities with the highest prevalence of HIV infection, "using a combination of effective strategies that seek to optimize entry into and retention in care and maintenance of viral suppression."
"Over the last three decades, prevention efforts have helped reduce new infections and treatment advances have allowed people with HIV to live longer, healthier lives," CDC Director Dr. Thomas Frieden said in a statement issued on June 2.. "But as these improvements have taken place, our nation’s collective sense of crisis has waned. Far too many Americans underestimate their risk of infection or believe HIV is no longer a serious health threat, but they must understand that HIV remains an incurable infection. We must increase our resolve to end this epidemic."