No Marked Change in HIV Prevalence in US Adults

Megan Brooks

September 24, 2015

There's been no significant change in the prevalence of HIV infection among US adults, according to the latest estimates released today in the Centers for Disease Control and Prevention's (CDC's) National Health Statistics Reports .

From 2007 to 2012, the prevalence of HIV infection among US adults aged 18 to 59 years was 0.39%, down only slightly from the prior estimate of 0.47% for the period 1999 to 2006 among 18- to 49-year-olds, report Joseph Woodring, DO, MPH, and colleagues at the CDC.

The updated HIV prevalence estimates are based on data from 10,466 adults aged 18 to 59 years who responded to the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012.

HIV prevalence increased with age, from 0.24% among 18- to 39-year-olds to 0.64% among those aged 50 to 59 years, but this wasn't statistically significant. HIV prevalence was higher in men than women (0.61% vs 0.16%, P < .01) and in non-Hispanic blacks than other race/ethnicity groups combined (1.6% vs 0.23%, P < .001).

Factors associated with HIV infection include a history of being in a high-risk group, having received healthcare in the past year, herpes simplex virus-2 infection, a history of 10 or more lifetime sexual partners, a history of sexually-transmitted infection, or same-sex sexual contact among men.

Only about half (51.9%) of HIV-infected adults used antiretroviral therapy (ART) in the past month, although this estimate is based on "limited" data and is "highly unstable" with wide 95% confidence intervals, the researchers say.

Use of ART was higher among non-Hispanic whites compared with non-Hispanic blacks (88.4% vs 30.7%) and among men relative to women (61.5% vs 16.7%). ART use increased with age and was greater in those with health insurance.

The report also shows that 86.1% of HIV-infected adults have a history of being tested for HIV outside of blood donations, compared with 43.5% of HIV-negative adults. Among HIV-infected adults, testing rates were higher in men than women, in those with a higher number of lifetime sexual partners, and among men having sex with men.

The authors highlight several limitations in the data analysis including "possible bias resulting from those at the highest risk not being within the scope of the NHANES sample (i.e., outside of the civilian, noninstitutionalized household population — incarcerated, institutionalized, or homeless populations, among others), or those at the highest risk being more likely not to respond to the survey. In addition, reporting bias may exist with sexual risk behaviors and illicit drug use, which may have led to underreporting by certain subpopulations."

Despite these and other limitations, they say it's important to monitor national trends of HIV prevalence and HIV risk factors to better understand health behaviors and characteristics influencing these trends.

According to the CDC, 1.2 million people are living with HIV in the US and an estimated 50,000 become infected annually. About 1 in 5 HIV-infected persons don't know they are infected and these individuals are estimated to transmit more than half of all infections. The Healthy People 2020 goal is for 90% of HIV-positive people to be aware of their status by 2020.

Natl Health Stat Rep. Published online September 24, 2015. Full text.


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