Vital Signs

Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis

United States, 2013-2018

Norma S. Harris, PhD; Anna Satcher Johnson, MPH; Ya-Lin A. Huang, PhD; Dayle Kern, MA; Paul Fulton; Dawn K. Smith, MD; Linda A. Valleroy, PhD; H. Irene Hall, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(48):1117-1123. 

In This Article

Abstract and Introduction

Abstract

Background: Approximately 38,000 new human immunodeficiency virus (HIV) infections occur in the United States each year; these infections can be prevented. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates three strategies (diagnose, treat, and prevent HIV infection) and seeks to leverage testing, treatment, and preexposure prophylaxis (PrEP) to reduce new HIV infections in the United States by at least 90% by 2030. Targets to reach this goal include that at least 95% of persons with HIV receive a diagnosis, 95% of persons with diagnosed HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP. Using surveillance, pharmacy, and other data, CDC determined the current status of these three initiative strategies.

Methods: CDC analyzed HIV surveillance data to estimate annual number of new HIV infections (2013–2017); estimate the percentage of infections that were diagnosed (2017); and determine the percentage of persons with diagnosed HIV infection with viral load suppression (2017). CDC analyzed surveillance, pharmacy, and other data to estimate PrEP coverage, reported as a percentage and calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons with indications for PrEP.

Results: The number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500) (p = 0.448). In 2017, an estimated 85.8% of infections were diagnosed. Among 854,206 persons with diagnosed HIV infection in 42 jurisdictions with complete reporting of laboratory data, 62.7% had a suppressed viral load. Among an estimated 1.2 million persons with indications for use of PrEP, 18.1% had been prescribed PrEP in 2018.

Conclusion: Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.

Introduction

Since 2013, progress in reducing the number of new human immunodeficiency virus (HIV) infections has stalled at approximately 38,000 new infections occurring each year.[1] Infections are preventable. Persons who are aware that they have HIV infection and maintain a suppressed viral load (<200 copies of HIV RNA per mL) have effectively no risk of sexually transmitting the virus to HIV-negative partners.[2] Nevertheless, 38% of new HIV infections are transmitted from persons with HIV infection who are unaware of their infection. Further, 43% of new HIV infections are transmitted from persons who have received a diagnosis but are not receiving HIV medical care, and 20% of new HIV infections are transmitted from persons receiving medical care for HIV, but who are not virally suppressed.[3] Preexposure prophylaxis (PrEP), a daily oral pill that includes two HIV antiretroviral medications (tenofovir and emtricitabine), has been found to be highly effective in preventing acquisition of HIV infection.[4] PrEP coverage has increased in recent years; however, coverage among persons at risk for exposure remains low.[5] In February 2019, a new national initiative, Ending the HIV Epidemic: A Plan for America, was proposed. The plan calls for intensified efforts to diagnose, treat, and prevent HIV infections in the United States, with an overall goal of reducing new infections by at least 90% by 2030.[6] Use of PrEP is a major component of the prevention strategy and is indicated for men and women with sexual or injection drug use behaviors that increase their risk for acquiring HIV.[7] To focus national and local prevention efforts on eliminating HIV, CDC analyzed surveillance, pharmacy, and other data to determine the status of these strategies (diagnose, treat, and prevent HIV infections) at the national and state levels.

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