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US HIV infections decline, but fail to meet national goals
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The number of annual HIV infections decreased by approximately 11% from 2010 to 2015, while the rate of HIV transmission declined by 17% during the same period, according to estimates from a recent analysis.
While these gains are encouraging, they fall short of the 25% reduction in HIV incidence and 30% reduction in transmission targeted by the National HIV/AIDS Strategy (NHAS), according to Robert A. Bonacci, MPH, fourth-year medical student at the University of Pennsylvania’s Perelman School of Medicine, and David R. Holtgrave, PhD, professor and chair of the department of health, behavior and society at Johns Hopkins Bloomberg School of Public Health.
David R. Holtgrave
“The good news is that we appear to have made important strides in the prevention of HIV and the reduction of HIV transmission rates in the United States; unfortunately, these key gains only got us roughly halfway to the 2015 goal line,” Holtgrave said in a press release. “After the release of the first [NHAS], researchers cautioned that failure to expand diagnostic, prevention and care services to necessary levels would result in underachievement on the NHAS goals for 2015. Our analysis suggests that is just what happened.”
Future progress requires look at ‘lessons learned’
Using 2007-2012 CDC surveillance data and literature-based estimates, Bonacci and Holtgrave constructed a mathematical model to estimate 2013-2015 trends in HIV incidence and transmission rates. The researchers then calculated the net perfect change of estimated incidence and transmission from 2010 to 2015, comparing them with the 2015 goals of the NHAS. Reproductive rate, infection elimination and sensitivity analyses also were conducted.
With the launch of the NHAS in 2010, the annual U.S. incidence of HIV was 37,366, all-cause mortality for people living with HIV (PLWH) was 17,866, and prevalence was 1,181,300. In 2015, incidence and all-cause mortality decreased to 33,218 and 16,085, respectively, while prevalence increased to 1,270,755. While the HIV transmission rate was 3.16 in 2010, it fell to 2.61 in 2015. Modest declines also were observed among HIV reproductive rates, and results were largely corroborated by the sensitivity analysis.
Robert A. Bonacci
Taken together, these changes represent an 11.1% decline in HIV incidence and a 17.36% decline in transmission, Bonacci and Holtgrave wrote, and fall short of key goals outlined in the NHAS. Furthermore, these data support some earlier claims that scale-up of HIV treatment and care alone would not be enough to meet the national goals.
“Going forward, as we implement the recently released updated NHAS for 2020, we must take a critical look at the past 5 years and apply the lessons learned to maximize the impact on our communities most affected by HIV,” Bonacci said in the release.
Reaching targets could prevent 185,000 new infections by 2020
The updated NHAS aims to increase the proportion of PLWH who are diagnosed with the disease to 90%, linkage to care to 85%, and the proportion of PLWH who are diagnosed and achieve viral suppression to 80%.
According to a forecasting model developed by CDC researchers, achieving the NHAS goal of increasing the proportion of those who are both diagnosed and virally suppressed to 80% alone would prevent more than 168,000 new infections by 2020. Increasing the use of PrEP among high-risk groups to the same level would spare nearly 17,000 more from contracting the disease within the next 5 years.
Furthermore, even if testing and treatment rates remained at current levels, the expansion of PrEP could potentially reduce HIV incidence by 18% — or more than 48,000 cases — by 2020. If each goal was achieved by the cutoff date, researchers estimated that approximately 185,000 new infections within the country could be avoided.
Jonathan Mermin
“If we expand the use of our current prevention strategies today, we can significantly reduce new HIV infections tomorrow,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a related press release. “This study confirms that we have the right tools to dramatically reduce new HIV infections, but we have a long way to go in order to make those reductions a reality.” – by Dave Muoio
References:
Bonacci RA, et al. AIDS Behav. 2016;doi:10.1007/s10461-016-1416-8.
Yaylali E, et al. Abstract 1051. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.
Disclosures: Bonacci, Holtgrave and Mermin report no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
As a country, we continue to make real progress against HIV transmission and AIDS-related deaths. Of course there is still much to be done to finally end our epidemic. Seeing the dramatic uptake of prevention measures in cities like San Francisco actually makes me optimistic. As more are treated across the CD4-defined spectrum of HIV disease — which will decrease secondary spread — and as PrEP gains ground among our men who have sex with men communities, we can hope to see real gains in our epidemic control goals. But we must continue to advocate for those efforts and especially ensure they reach our most marginalized groups, especially young MSM of color and rural populations. We have the tools we need, and must keep using them wisely. This is a battle that can be won.
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