March 20, 2019

How is HIV spreading in the US? A gap in treatment, CDC finds.

Daily Briefing

    A majority of new HIV transmissions in the United States in 2016 stemmed from individuals with HIV who were not receiving treatment, according to a CDC Morbidity and Mortality Weekly Report released Monday.

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    For the report, researchers analyzed 2016 data from CDC's National HIV Behavioral Surveillance and National HIV Surveillance System.

    Findings

    Overall, researchers found the HIV transmission rate in the United States decreased from 4.5 per 100 person years in 2010 to 3.5 per 100 person years in 2016. The researchers attributed the decline mainly to a "steady increase" in patients with HIV who have suppressed the virus by undergoing treatment such as antiretroviral therapy.

    However, the researchers found about 80% of new HIV infections in 2016 stemmed from individuals with HIV who either knew or did not know they had the virus and did not receive treatment to suppress the virus. In particular, the researchers found:

    • 43% of new HIV transmissions stemmed from 23% of individuals with HIV who knew they had the virus, but did not receive adequate treatment; and
    • 38% of new HIV transmissions stemmed from 15% of individuals with HIV who did not know they had virus.

    According to the researchers, less than a quarter of new HIV infections stemmed from individuals with HIV who received adequate treatment. The researchers found that 20% of new HIV transmissions stemmed from 11% of individuals with HIV who received adequate treatment but did not achieve viral suppression. According to the researchers, no new HIV transmissions stemmed from individuals with HIV who received adequate treatment and achieved viral suppression.

    Comments

    CDC Director Robert Redfield said new HIV transmissions stemming from undiagnosed patients occur partly because physicians are not following CDC recommendations for HIV testing, which he called "diagnostic complacency." He said innovations in diagnostic testing might help address the problem by allowing individuals to order HIV testing kits online and be tested in "non-traditional [and] non-clinical setting[s]."

    Jonathan Mermin—director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB—said the report's findings "highligh[t] the gap preventing us from stopping HIV infections" and "emphasizes the impact HIV resources could have if we expanded HIV testing and treatment" (Hellmann, The Hill, 3/18; Walker, MedPage Today, 3/18; Brooks, Medscape, 3/19; Baker, "Vitals," Axios, 3/19).

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