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Many People with HIV Remain Untreated in the U.S., Less than a Third Have Suppressed Viral Load

Out of an estimated 1.2 million people living with HIV in the U.S., about 4 in 5 know their status, and of those, about half were receiving ongoing medical care in 2010, according to a new report from the Centers for Disease Control and Prevention (CDC). About three-quarters of people on consistent antiretroviral therapy (ART) -- but only 28% of HIV positive people overall -- maintain undetectable viral load, which has implications for both disease progression and viral transmission.

Viral suppression has gained increased emphasis recently as controlled trials have shown that people with undetectable viral load on ART reduced the likelihood of transmitting HIV to a sexual partner by nearly 100%. A growing body of evidence indicates that lowering "community viral load" -- or average viral load in a defined area -- can reduce HIV incidence on a population level.

The new CDC Vital Signs report, published in the November 29, 2011, early edition of Morbidity and Mortality Weekly Report, is based on 3 sets of surveillance data: National HIV Surveillance System (NHSS), Behavioral Risk Factor Surveillance System (BRFSS), and Medical Monitoring Project (MMP).

In 2010, an estimated 941,950 HIV positive people had been tested and knew they were infected. Out of this group, about three-quarters had been linked to care within 4 months of diagnosis, but the proportion that continued receiving care was lower, at 51%.

Nearly 90% of people referred to care were prescribed antiretroviral drugs. The treatment rate was generally high across the board, with similar rates for men and women (90% and 86%, respectively). Blacks and Hispanics/Latinos were somewhat less likely to receive treatment than whites (86%, 89%, and 92%, respectively), and younger people age 18-24 were less likely to receive therapy than those over 55 years (76% vs 92%, respectively).

Among people prescribed ART, 77% achieved undetectable viral load; 70% of blacks had full viral suppression compared with 79% of Hispanics and 84% of whites.

But looking at the entire population of people with HIV -- not just those who have been tested and diagnosed -- only 41% receive ongoing care and only 28% have undetectable viral load, meaning that a large percentage remain at risk for disease progression and viral transmission.

"HIV clinicians have excellent understanding of the [clinical] importance of suppressing viral load, but there may be less appreciation of the profound prevention effects," said CDC Division of AIDS director Jonathan Mermin during a media conference call to discuss the data. "Now we can be confident [ART] can reduce transmission by over 95%...this raises for clinicians the importance of making sure patients on ART have suppressed virus for own health and the health of their loved ones and sexual partners."

“While we have known that viral suppression can be achieved with proper HIV treatment and care, today’s new Vital Signs data highlight the challenges our country faces in keeping HIV-positive Americans in the care they need to control the virus,” said CDC Director Thomas Frieden. “By improving testing, linkage to care and treatment services, we can help people living with HIV feel better and live longer, and can reduce the spread of HIV dramatically.

In addition to announcing the Vital Signs data, the CDC also launched a new national HIV awareness campaign in advance of World AIDS Day. The Testing Makes Us Strongercampaign aims to increase HIV testing rates among black gay and bisexual men, the population with the highest incidence.

“Black gay and bisexual men across the country are already doing many of the right things to protect themselves -- but more need to make HIV testing a regular part of their lives,” said Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention. “Testing Makes Us Stronger was designed by black gay men for black gay men and strives to communicate the power of knowing your HIV status as a first step toward staying healthy.”

12/2/11

Reference

S Cohen, M Van Handel, B, et al. Vital Signs: HIV Prevention Through Care and Treatment -- United States. Morbidity and Mortality Weekly Report 60:1-6. November 29, 2011 (early release).

Other Source

Centers for Disease Control and Prevention. Only one quarter of Americans with HIV have virus under control. Press release. November 29, 2011.