The CDC has found that accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the US goal of at least 90% reduction in the number of the new HIV infections by 2030.

Approximately 38,000 new HIV infections occur in the United States each year. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates 3 strategies: diagnose, treat, and prevent HIV infection. The plan seeks to leverage testing, treatment, and pre-exposure prophylaxis (PrEP) to reduce HIV infections in the United States by at least 90% by 2030.

Targets of this initiative include that at least 95% of patients with HIV receive a diagnosis, 95% of persons with diagnosed with HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP.

In order to determine the current status of these 3 initiative strategies, the CDC analyzed data reported to the National HIV Surveillance System (NHSS) from the beginning of the epidemic in the early 1980s through June 2019 from 50 states and the District of Columbia for patients aged ≥13 years with diagnosed HIV infection.

NHSS data reported from 41 states and Washington, DC, that had complete laboratory reporting of viral load test results were used to determine 2 viral suppression measures: viral suppression among persons with diagnosed HIV infection in the jurisdiction at year-end 2017 and viral suppression within 6 months of diagnosis among persons with HIV infection diagnosed during 2017. These 42 jurisdictions represent 89% of persons with diagnosed HIV infection in the United States.

The CDC then used national pharmacy data from the IQVIA to estimate the number of patients aged ≥16 years who were prescribed PrEP in 2017 and 2018.

Among the estimated 1.2 million persons living with HIV infection in 2017, 85.8% had received a laboratory-confirmed diagnosis of HIV infection. The lowest percentages of persons with viral suppression were those aged 13–24 years (56.9%), African Americans (57.4%), and males who inject drugs (52.0%), compared with other age, racial/ethnic, and transmission risk groups.

An estimated 1.2 million persons had indications for PrEP; 12.6% were prescribed PrEP in 2017 and 18.1% in 2018. In 2018, PrEP coverage was 3 times as high among males (20.8%) as females (6.6%). Compared with other age groups, the lowest PrEP coverage rate was among persons aged 16–24 years at 11.4%. PrEP coverage was 5.9% for African Americans, 10.9% for Hispanics/Latino, and 42.1% for whites.

Overall, in 2017, 63% of persons with diagnosed HIV infection had a suppressed viral load and in 2018, PrEP coverage was low at 18%. These findings suggest substantial gaps in diagnosing, treating, and preventing HIV infection and underscore the need for expanded efforts.

“The targets for the proposed initiative are at least 95% of persons with HIV infection having received a diagnosis, 95% of persons with diagnosed HIV infection having a suppressed viral load, and 50% of persons with indications for PrEP having been prescribed PrEP. New infections will occur unless substantial improvements are made in implementing these three strategies,” the report added.

The report indicated that more PrEP coverage was needed for patients in racial/ethnic demographic groups, especially among young patients, African Americans, and Hispanics/Latinos at risk for acquiring HIV. Furthermore, to rapidly improve viral suppression for all populations, additional research is needed to identify interventions that will achieve viral suppression within 6 months of diagnosis, especially among populations facing severe health and socioeconomic challenges, including homelessness.

References
  1. Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis — United States, 2013–2018. CDC Morbidity and Mortality Weekly Report. Published December 6, 2019. https://www.cdc.gov/mmwr/volumes/68/wr/mm6848ehtm?s_cid=mm6848e1_w. Accessed December 13, 2019.