Only 3 in 10 Americans With HIV Have Virus Suppressed: CDC

Megan Brooks

November 25, 2014

Fewer than a third of Americans with HIV infection achieve viral suppression through effective care and treatment, according to new data released today by the Centers for Disease Control and Prevention (CDC).

"HIV care and treatment not only work to improve health and prolong lives, but also to prevent new infections. Yet today's study shows that too many people with HIV aren't getting the treatment they need in most cases because they aren't receiving ongoing HIV care," CDC Director Tom Frieden, MD, MPH, said during a press briefing.

According to the CDC's Vital Signs report, an estimated 1.2 million persons were living with HIV infection in the United States in 2011. Of these, an estimated 86% has been diagnosed with HIV, but only 40% were engaged in HIV medical care, 37% were prescribed antiretroviral therapy (ART), and 30% achieved viral suppression. The percentage achieving viral suppression was relatively stable from 2009 (26%) to 2011.

"In terms of numbers, there were 840,000 Americans with HIV who didn't have their virus suppressed, meaning they were at greater risk for health problems and at greater risk of spreading HIV to others," Dr Frieden said.

Among people whose viral load was not suppressed, 20% had never been diagnosed with HIV, 66% were diagnosed but were not engaged in HIV care, 4% were receiving HIV care but had not been prescribed ART, and 10% had been given ART but had not achieved viral suppression.

"Alarming" Statistic

There were no statistically significant differences in viral suppression by race or ethnicity, sex, or risk group. However, younger people were significantly less likely than older people to have their virus under control.

Only 13% of people aged 18 to 24 years were virally suppressed compared with 23% of those in the 25-to-34 age bracket, 27% of those aged 35 to 44 years, 34% of those aged 45 to 54 years, and roughly 36% among those aged 55 years or older.

The CDC says the disparity is largely due to the fact that fewer than half (49%) of 18- to-24-year-olds with HIV have been diagnosed, underscoring the need for more HIV testing in this population.

"It's alarming that fewer than half of HIV-positive young adults know they are infected," Eugene McCray, MD, director of the CDC's Division of HIV/AIDS Prevention, said in a statement. "Closing that gap could have a huge impact on controlling HIV — knowing your status is the first critical step toward taking care of your own health and avoiding transmission to others."

Most people with HIV who regularly take ART achieve viral suppression, which reduces the likelihood of transmission, Dr Frieden noted. Current clinical guidelines now recommend that everyone diagnosed with HIV begin treatment as soon as they are diagnosed. "This is consistent with the way we treat most infections," he said.

"There is untapped potential to drive down the epidemic through improved testing and treatment, but we're missing too many opportunities," Jonathan Mermin, MD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, said in the statement. "Treatment is crucial. It is one of our most important strategies for stopping new HIV infections."

"State and local health departments, community-based organizations, and health care providers play essential roles in improving outcomes on the HIV care continuum that increase survival among persons living with HIV and prevent new HIV infections," the Vital Signs report concludes.

"The greatest opportunities for increasing the percentage of persons with a suppressed viral load are reducing undiagnosed HIV infections and increasing the percentage of persons living with HIV who are engaged in care," the report says.

Vital Signs. Published online November 25, 2014. Full text

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