Most Americans With HIV Don't Have Virus Under Control, CDC Says

U.S. experts cite indifference, lack of access to care

Tuesday, November 25, 2014

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TUESDAY, Nov. 25, 2014 (HealthDay News) -- Fewer than one-third of Americans living with HIV had the virus under control in 2011, with many either not receiving regular medical care or unaware they carry the virus, a new U.S. study finds.

The U.S. Centers for Disease Control and Prevention study estimates that 70 percent of the 1.2 million Americans living with HIV in 2011 did not have their virus under control, even though combination drug therapies can effectively suppress the virus before it can develop into full-blown AIDS.

A combination of indifference and lack of access to medical care appeared to outweigh ignorance as a driving factor in cases of uncontrolled HIV, researchers from the CDC's National Center for HIV/AIDS reported Tuesday.

"For people living with HIV and AIDS, it's not enough to know -- you also have to go for health care," said CDC Director Dr. Tom Frieden at a Tuesday news briefing.

"For health care systems, it's not enough to diagnose patients," he added. "You have to take accountability and responsibility for every patient diagnosed in your health center, to provide them with the most sensitive, effective, culturally appropriate care so that they will get onto treatment, stay into treatment, live longer, live healthier, stay out of the hospital and not infect others."

When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body, allowing people with HIV to live longer, healthier lives, Frieden said.

Viral suppression also reduces the likelihood that patients will transmit HIV to others. Treatment has been shown to reduce sexual transmission of HIV by 96 percent, the CDC said, and U.S. clinical guidelines recommend that everyone diagnosed with HIV receive treatment.

Among the nearly 840,000 people who had not achieved viral suppression, researchers found that:

66 percent had been diagnosed but were not engaged in regular HIV care;
20 percent did not yet know they were infected;
4 percent were getting some care but weren't prescribed antiretroviral treatment;
10 percent were prescribed antiretroviral treatment but had not been able to fully suppress their HIV.

The study did not find statistically significant differences in viral suppression by race, ethnicity or gender, which is "encouraging," said Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.

But researchers did find that young adults are at greater risk of uncontrolled HIV, with only 13 percent of people age 18 to 24 having achieved viral suppression. "More than any other group, our young people are not getting the care they need," said Mermin, also speaking at the news briefing.

This is largely because young adults are less likely to have been diagnosed with HIV. Only half of those 18 to 24 with HIV have been diagnosed, compared with more than 90 percent of people 45 and older, the report said.

"To close the age gap in viral suppression, we will need to expand efforts to reach young adults with HIV testing," Mermin said.

Mermin said that accessing HIV care can be difficult, particularly for people who are impoverished or suffering from substance abuse problems.

But even people of means can find it hard to maintain HIV treatment, Frieden said.

"Taking treatment for an infection that may have no symptoms and that you need to take for life is not easy," he said. "That's why it's so important that services for people living with HIV be sensitive, easy to access and without financial barriers."

The CDC hopes to improve HIV diagnosis and treatment through efforts launched in 2010 as part of the National HIV/AIDS Strategy, said Dr. Eugene McCray, director of the CDC's Division of HIV/AIDS Prevention, at the news briefing.

McCray said these efforts include innovative partnerships to make HIV testing simple, accessible and routine.

Additional efforts include programs to help health departments identify infected individuals who have fallen out of care. Public awareness campaigns about the importance of HIV testing and ongoing HIV treatment are also key, McCray said.

SOURCES: Tom Frieden, M.D., M.P.H., Director, U.S. Centers for Disease Control and Prevention; Jonathan Mermin, M.D., M.P.H., Director, U.S. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Eugene McCray, M.D., Director, CDC Division of HIV/AIDS Prevention; CDC Vital Signs report, Nov. 25, 2014

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