December 03, 2019
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‘In this case, stability is not good’: HIV incidence at a standstill in US

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Progress in reducing new HIV infections in the United States has stalled in recent years, according to newly published CDC data. Experts said accelerated efforts to diagnose, treat and prevent HIV infection are needed to achieve a 90% reduction in new diagnoses by 2030 — one of the goals of a federal HIV plan announced earlier this year.

“The HHS and its agencies have taken on the goal of ending the HIV epidemic in America by 2030. This is an ambitious goal, but with swift and bold actions, not only is it achievable, but we can get it done and we can end the status quo provided that we can change our expectations and the culture of satisfaction with where we’re at now,” Jay C. Butler, MD, CDC’s deputy director of infectious diseases, said during a media briefing.

“Today’s report shows [that] HIV testing, treatment and preventions have not reached enough Americans and emphasizes the continued urgent need to increase these interventions.”

According to a Vital Signs report, CDC researchers analyzed national HIV surveillance data to estimate the annual number of new HIV infections between 2013 and 2017, estimate the percentage of infections that were diagnosed in 2017 and determine the percentage of persons with diagnosed HIV infection with viral load suppression in 2017. They also analyzed surveillance and pharmacy data to estimate the percentage of patients with an indication for pre-exposure prophylaxis (PrEP) who were taking the HIV prevention medicine.

Among the key findings, researchers reported that in 2017, an estimated 14% of people with HIV — approximately 154,000 people — did not know that they were infected. One of the goals of the new federal plan is that at least 95% of patients with HIV know they are infected.

“Without a diagnosis, they could not take advantage of treatment that would help them stay healthy and stop transmission to others,” Eugene McCray, MD, director of the CDC's Division of HIV/AIDS Prevention, said during the briefing.

In 2017, a little more than a third of those who knew they had HIV — or approximately 318,000 people — were not virally suppressed, well short of the goal of achieving viral suppression in 95% of infected patients.

“Good treatment is good prevention,” McCray said. “Viral suppression is a marker for effective HIV treatment.”

The researchers estimated that 1.2 million Americans could benefit from PrEP, but only about 152,000 were prescribed PrEP in 2017 and about 220,000 in 2018, or just 18.1%. The goal is 50% coverage.

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Earlier this year, HHS announced that Gilead Sciences had agreed to donate free PrEP for up to 200,000 patients each year for up to 11 years in a program that will focus on underserved, high-risk and low-income areas.

“There has been a rapid increase in PrEP uptake, but there is no doubt that PrEP uptake is still too low,” McCray said. “We are working hard to increase access to PrEP.”

Finally, the report showed that the number of people who acquire HIV each year remained at a standstill, with around 37,500 new HIV infections reported in 2017 compared with 38,500 in 2013.

“In this case, stability is not good,” McCray said. “These findings underscore the urgent need to rapidly scale up HIV testing, treatment and PrEP.”

He added, “Our national goals can be accomplished with the right use of science, technology and resources, and a continued commitment of people with HIV, communities affected by HIV and public and private leadership all working together.”– by Caitlyn Stulpin

Disclosures: Butler and McCray report no relevant financial disclosures.