Since 2013, progress in reducing the number of new HIV infections in the United States has stalled at about 38,000 new infections occurring each year, the Centers for Disease Control and Prevention (CDC) reports.

“Accelerated efforts to diagnose, treat, and prevent HIV infection are urgently needed,” the CDC emphasized.1

The first cases of what would come to be known as HIV/AIDS were detected in the United States in 19812 and since then, the infection has killed about 35 million people across the globe. It is one of the great plagues in human history, but evidence is growing that the tools to finally stop transmission are at hand, even as research on an elusive vaccine continues.

“Ending the HIV epidemic would be one of the greatest public health triumphs in our nation’s history,” Eugene McCray, MD, director of the division of HIV/AIDs prevention at the CDC, said at a recent press conference.

CDC officials updated an ambitious plan to essentially end the AIDS epidemic in the United States in the next decade. While taking an overall national approach, the plan — part of a collaboration between the CDC and other federal agencies — would target specific geographic areas and at-risk populations. The goals are a 75% reduction in infections in the next five years and a 90% reduction in 10 years.3 (See Hospital Infection Control & Prevention, May 2019.)

“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 pre-exposure prophylaxis (PrEP). PrEP contains two HIV antiretroviral medications (tenofovir and emtricitabine). The CDC estimates that one prophylaxis pill a day taken by an uninfected, at-risk person is 97% effective at preventing HIV transmission from an untreated sex partner.

However, only 18% of the 1.2 million people indicated for PrEP were prescribed the drugs in 2018. For those already infected, today’s treatments are so effective that viral loads can be suppressed so low (< 200 copies of HIV ribonucleic acid [RNA] per mL) that there is “effectively no risk of sexually transmitting the virus” the CDC report states.

Despite this, the United States is on track to have almost 400,000 new HIV infections this decade, even though an array of prevention and treatment improvements are now available.  

“Nevertheless, 38% of new HIV infections are transmitted from persons with HIV infection who are unaware of their infection,” the CDC states. “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.”

“It emphasizes the continued urgent need to increase these interventions,” says Jay Butler, CDC’s deputy director for infectious diseases. “The science is there, we have the tools. There’s a critical need to fully engage the community to include new voices and build capacity.”

Part of that will be rooting out HIV in sectors with grim socioeconomic conditions, including those infected or at risk among the homeless, addicted, and those with untreated mental health issues.

“More than 150,000 Americans still don’t know that they have HIV, and need to be tested,” Butler says. “Not enough Americans with HIV have the virus under control through effective treatments.”

REFERENCES

  1. Harris NS, Johnson AS, Huang YA, et al. Vital signs: Status of human immunodeficiency virus testing, viral suppression, and HIV preexposure prophylaxis – United States, 2013–2018. MMWR Morb Wkly Rep 2019;68;1117–1123.
  2. CDC. Pneumocystis pneumonia — Los Angeles. MMWR Morb Wkly Rep 1981;30:250–252.
  3. HHS. Ending the HIV epidemic: A plan for America. Available at: https://bit.ly/2soch9y. Accessed Dec. 9, 2019.