EXECUTIVE SUMMARY

New information from the Centers for Disease Control and Prevention indicates the estimated median time from HIV infection to diagnosis improved from three years and seven months in 2011 to three years in 2015.

  • This improvement, combined with other recent developments, indicates the nation’s approach to HIV prevention is successful, officials say.
  • While the percentage of people who are at increased risk for HIV who reported receiving an HIV test in the previous year has increased, too few are being tested, public health officials say. Results from a multi-city study found that of those who reported that they did not have an HIV test in the last year, 29% identified themselves as gay and bisexual men, 42% as injecting drug users, and 59% as heterosexuals at increased risk for HIV.

New information from the Centers for Disease Control and Prevention (CDC) indicates that the estimated median time from HIV infection to diagnosis improved from three years and seven months in 2011 to three years in 2015.1 This improvement, combined with other recent developments, indicates the nation’s approach to HIV prevention is successful, officials say.

Information indicates that of the estimated 1.1 million people who were living with HIV in the United States in 2014, 85% knew their HIV status.2 Despite this progress, the new report also highlights ongoing challenges, says Brenda Fitzgerald, MD, CDC director.

“For example, many Americans aren’t getting tested for HIV as CDC recommends,” said Fitzgerald in a press briefing. “And too many people have HIV infections that go undiagnosed for far too long.”

Review the Data

The new analysis suggests that while the percentage of people who are at increased risk for HIV has grown, there are still gaps in testing. Results from a multi-city study found that of those who reported that they did not have an HIV test in the last year, 29% identified themselves as gay and bisexual men, 42% as injecting drug users, and 59% as heterosexuals at increased risk for HIV.

Without increased testing, many people who are living with undiagnosed HIV may not know they have HIV for many years. Data indicate that 25% of those who were diagnosed with HIV in 2015 had lived with the disease for seven years or more without knowing it.1

Disparities Exist

In the new report, the estimated time from HIV infection to diagnosis was different according to risk group and by race/ethnicity. The estimated time from HIV infection to diagnosis varied from a median of five years for heterosexual males and two-and-a-half years for heterosexual females to a median of three years for gay and bisexual males.
When analyzed by race, statistics indicate the estimated time from HIV infection to diagnosis ranged from a median of four years for Asian Americans, three years for African Americans and Latinos, to two years for white Americans.

“Ideally, HIV is diagnosed within months of infection, rather than years later,” said Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention, in a prepared statement. “Further increasing regular HIV testing and closing testing, diagnosis and treatment gaps is essential to stopping HIV in our communities.”

Work to Close the Gap

To close the gap in time from HIV infection to diagnosis, the CDC is working on several fronts to achieve this goal, says McCray. It is educating the public and healthcare providers about the importance of testing, prevention, and treatment, as well as funding health departments and community-based organizations to conduct HIV testing programs. It also is developing new testing recommendations to help diagnose HIV earlier, when people are most likely to transmit the virus. CDC funding supports more than 3 million tests yearly across the country that identify more than 12,000 people with HIV, on average, who were not diagnosed previously.

CDC guidance calls for all people 13-64 years of age to receive screening for HIV at least once. Those who are at higher risk for HIV infection, including sexually active gay, bisexual, and other men who have sex with men (MSM), should receive rescreening at least annually.3

In a 2017 update, the agency concluded that the evidence is not sufficient to warrant changing the current recommendation for annual screening for MSM to more frequent screening.4 Clinicians also can consider the possible benefits of HIV screening that is more frequent (every three or six months) for some sexually active MSM who are asymptomatic, based on their individual risk factors, local HIV epidemiology, and local policies, the update stated.

“The Vital Signs Report also found seven in 10 people at high risk who were not tested for HIV in the past year saw a healthcare provider during that time, signaling a missed opportunity for high-risk individuals to be tested as frequently as needed,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta, reminds readers that any HIV diagnosis should lead to intense discussion of condom use.

REFERENCES

  1. Dailey AF, Hoots BE, Hall HI, et al. Vital signs: Human immunodeficiency virus testing and diagnosis delays — United States. MMWR Morb Mortal Wkly Rep 2017;66:1300-1306.
  2. Centers for Disease Control and Prevention. HIV incidence: Estimated annual infections in the U.S., 2008-2014, overall and by transmission route. Fact sheet. Available at: http://bit.ly/2kWMlIA. Accessed Dec. 20, 2017.
  3. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006;55(RR-14):1-17.
  4. DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men — United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:830-832.