The Latest "Vital Signs" for the U.S. HIV Epidemic Suggest an Emergency

Carlos del Rio, MD


AIDS Clinical Care 

In This Article

Abstract and Introduction


Only 28% of HIV-infected individuals in the U.S. have achieved virologic suppression, and the case-fatality rate remains high, especially in the South.


This year marked the 30th anniversary of the first reported cases of HIV/AIDS in the U.S. Although progress in treatment has been immense, the latest nationwide data illustrate the need for much greater effort across the spectrum of care.

CDC investigators combined data from the published literature and three national surveillance systems to get a snapshot of the HIV epidemic in the U.S. They estimate that in 2008, 1.2 million people in the U.S. were living with HIV infection, but only 80% had received a diagnosis. Approximately 77% of those diagnosed were linked to care within 3 to 4 months, but only 51% were retained in ongoing care. Of those receiving care, 89% were prescribed antiretrovirals, and of these, 77% had a viral load ≤200 copies/mL on their most recent test. Based on these data, the investigators estimate that only 35% of those with diagnosed HIV infection — and only 28% of those living with HIV — in the U.S. have achieved virologic suppression.

Striking disparities were seen at various stages of care. For example, the prevalence of HIV diagnosis in individuals aged 18 to 64 varied widely among states, from 40 to 3365 cases per 100,000 population. And among patients on treatment, the proportion with undetectable viral loads was higher among men than women (79% vs. 71%), among whites than blacks (84% vs. 70%), and among those aged ≥55 than those aged 25 to 34 (85% vs. 69%); it was also higher among men who have sex with men than among men who have sex only with women or among women who have sex with men (81% vs. 75% and 71%, respectively).

In a separate study, Hanna and colleagues described large differences in HIV-related mortality by state between 2001 and 2007. The HIV case-fatality rate per 1000 person-years was 20.6 overall but ranged from 9.6 in Idaho to 32.9 in Mississippi. Nine of the 10 states with the highest case-fatality rates were located in the South.


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