More Americans Getting Tested for HIV, Diagnosis Delays Down

Megan Brooks

November 28, 2017

The United States has made strides in diagnosing HIV infection earlier after becoming infected, although many people still have HIV for years before they know it, federal health officials with the Centers for Disease Control and Prevention (CDC) said today.

Among the 39,270 persons diagnosed with HIV infection in 2015, the estimated median time from infection to diagnosis was 3.0 years, down from 3 years, 7 months in 2011, according the November 28 Vital Signs report.

The 7-month improvement is a "considerable" decrease over a 4-year period and reinforces other recent signs that the nation's approach to HIV prevention is paying off, the CDC said in a news release.

"Overall, [the report] reveals that we as a nation are making great progress on HIV prevention," CDC Director Brenda Fitzgerald, MD, said during a press briefing. "People at risk of HIV are getting tested more frequently, and HIV is being diagnosed sooner after infection. Annual HIV infections are down, and a higher proportion of all people living with HIV have gotten diagnosed, and more people with HIV have the virus under control through treatment. These are all very encouraging signs," she said.

"Yet despite this progress, today's report also highlights ongoing challenges," Dr Fitzgerald said. "Many Americans aren't getting tested for HIV as CDC recommends, and too many people have HIV infections that go undiagnosed for far too long."

The Vital Signs report also shows that delays in diagnosing HIV vary by race and ethnicity (from 2.2 years among whites to 4.2 years among Asians) and among transmission category (from 2.0 years among female injection drug users to 4.9 years among heterosexual males). The median delay was 3 years for gay and bisexual males. A quarter of people diagnosed with HIV in 2015 had lived with HIV for 7 or more years without knowing it.

The CDC recommends testing all people aged 13 to 64 years for HIV at least once in their lifetime and that people at higher risk for HIV be tested at least annually. Healthcare providers may find it beneficial to test some sexually active gay and bisexual men every 3 to 6 months, the agency said.

According to the CDC, an estimated 40% of ongoing HIV transmissions in the United States stem from people who do not know they have the virus. And although prior-year testing has increased over time among groups at high risk for HIV infection, CDC data show that 29% of gay and bisexual men, 42% of injection drug users, and 59% of heterosexuals at increased risk did not undergo HIV testing in the past 12 months.

In each risk group, at least two thirds of individuals who did not have an HIV test had seen a healthcare provider in the past year, "signaling a missed opportunity" to get people tested, Jonathan Mermin, MD, MPH, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said at the briefing.

"We know that an HIV test opens doors to care, treatment, and prevention," Dr Fitzgerald added, "but we are still missing opportunities to test many people who are most at risk for HIV. So while we should celebrate our progress, we must still make HIV prevention a priority. This is an epidemic we can stop."

MMWR Morb Mortal Wkly Rep. Published online November 28, 2017. Full Text

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