70% of HIV Cases Are Not Under Control

Only one-third of the 1.2 million people with HIV in the US have the virus under control, according to a new report from the Centers for Disease Control and Prevention (CDC).

The Vital Signs report, which analyzes HIV data for 2011, also found that about two-thirds of those who don’t have their HIV levels under control had been diagnosed but were no longer receiving care and about 20% didn’t know that they had HIV. 
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“Key to controlling the HIV epidemic is controlling the virus,” says Heather M. Bradley, PhD, an epidemiologist with the CDC’s Division of HIV/AIDS Prevention who contributed to the report. “The report underscores the importance of making sure people with HIV receive ongoing care, treatment, and other information and tools that help prevent transmission to others, as well as the need to reach more people with HIV testing.”

The researchers found that while viral suppression did not differ significantly by race, ethnicity, sex, or risk of infection, the proportion of people with the virus under control increased with age:

• 13% among those ages 18-24

• 23% among those ages 25-34

• 27% among those ages 35-44

• 34% among those ages 45-54

• 36% among those ages 55-64

• 37% among those ages 65 and older

Younger people are significantly less likely than older people to have their virus levels under control, in part because only half (49%) of 18- to 24-year-olds with HIV have been diagnosed.

“HIV testing is the critical first step for prevention and care. People who don’t know they are infected can’t access HIV care and treatment, or take steps to protect their sexual partners,” Bradley says. “Everyone should get tested for HIV at least once, as part of routine health care.  Those at higher risk should get tested more often.” 

She says the CDC has a number of efforts underway to increase HIV testing, including some directed specifically toward youth, as well as new programs to help health departments identify and reach out to infected individuals who have fallen out of care.

“Health care providers play a critical role in testing and diagnosing patients, getting and keeping people with HIV in medical care, prescribing medicines, and helping patients achieve viral suppression,” Bradley says. “Health care providers can also help link their patients to supportive services—like nutrition and mental health services—that can help them to stay in care and on medications.” 

When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body, allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others.

Evidence shows that treatment can reduce sexual transmission of HIV by as much as 96%, and US guidelines recommend treatment for all people diagnosed with HIV, regardless of their viral load.

“Treatment is one of our most important strategies for stopping new HIV infections. HIV care and treatment work, not only to improve health and prolong lives, but also to prevent transmission to others,” Bradley says. “By expanding access to care and treatment, we will save lives and help put an end to HIV in this country.”

—Colleen Mullarkey

Reference:

Centers for Disease Control and Prevention. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR. 2014 Nov 25;63(47);1113-7.