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New HIV infections decline 18% in US
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SEATTLE —The overall number of annual HIV infections in the United States declined 18% over a 6-year period, with approximately 45,700 new infections occurring in 2008 and 37,600 occurring in 2014, according to new CDC estimates presented at the Conference on Retroviruses and Opportunistic Infections 2017. Progress, however, was lacking in certain populations.
“These declines in annual infections are a promising sign that HIV prevention efforts are paying off and reflect the success of collective prevention and treatment efforts at the national, state and local levels,” CDC researcher Sonia Singh, PhD, said during a press conference. “We believe that one major driver of the progress is the growing proportion of people living with HIV who are aware of their infection and virally suppressed. This is a top public health priority.”
Declining trends in HIV incidence
CDC researchers used a new method combining data from the National HIV Surveillance System on HIV diagnoses and the first CD4 test result after diagnosis to estimate the incidence of HIV in 2014 and trends that occurred from 2008 to 2014. In addition to an overall decline in new infections nationwide, there was a 56% decline among people who inject drugs (PWID; 3,900 to 1,700), a 36% decline among heterosexuals (13,400 to 8,600) and an 18% decline among young men who have sex with men (MSM) aged 13 to 24 years (9,400 to 7,700) and white MSM (9,000 to 7,400). Increasing use of pre-exposure prophylaxis (PrEP) may have contributed to these reductions, Singh said.
The percentage of undiagnosed infections decreased among all MSM racial/ethnic groups. In 2014, the percentage of undiagnosed infections was 20.4% in black MSM (95% CI; 18.5%-22.2%), 20.9% (95% CI; 18.6%-23.1%) in Hispanic MSM and 12.5% (95% CI; 11.0%-14.0%) in white MSM. Reductions were further observed when stratified by age. The percentage of undiagnosed infections decreased from 70.1% to 52.0% in MSM aged 13 to 24 years, and from 32.3% to 30.1% MSM aged 25 to 34 years (P < 0.05).
A regional analysis including data on 35 states and Washington, D.C. showed that annual infections either decreased or remained stable. Substantial reductions were reported in Washington, D.C. (10% decline), Maryland (8% decline), Pennsylvania (7% decline), Georgia (6% decline), New York and North Carolina (5% decline for both), Illinois (4% decline), and Texas (2% decline). Singh noted that the South continues to be the most affected region in the country, accounting for 50% of estimated infections in 2014 despite representing only 37% of the U.S. population.
More progress needed in high-risk groups
MSM were the only group that did not have an overall reduction in annual infections, according to Singh. The number of new infections remained stable among all MSM at an estimated 26,000 new infections per year, and among black MSM, who accounted for approximately 10,000 new infections per year.
“This stabilization is an encouraging sign, particularly after more than a decade of increases among these populations,” Singh said.
There was, however, a 35% increase in infections among MSM aged 25 to 35 years (7,200 to 9,700) and a 20% increase among Hispanic MSM (6,100 to 7,300).
Although the number of HIV infections declined among PWID, Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release that the nation’s ongoing opioid epidemic may threaten recent reductions in HIV incidence.
“The opioid epidemic in our country is jeopardizing the dramatic progress we’ve made in reducing HIV among people who inject drugs,” he said. “We need to expand the reach of comprehensive syringe services programs, which reduce the risk of HIV infection without increasing drug use, and can link people to vital services to help them stop using drugs.”
Singh concluded that future analyses will examine racial and ethnic disparities in HIV incidence, and that additional efforts are needed in order to achieve goals outlined in the National HIV/AIDS Strategy.
“Our findings point to the need to intensify high-impact, cost-effective prevention efforts for Americans who need them, including Latino gay and bisexual men, and gay and bisexual men aged 25 to 34 years, as well as a continued focus on the South,” Singh said. “This means ensuring that HIV testing is simple and routine, that people living with HIV get care and treatment starting from the day that they receive their diagnosis, and that people who are not infected with HIV have prevention information tools, including syringe service programs and PrEP where appropriate.” – by Stephanie Viguers
Reference:
Singh S, et al. Abstract 30. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carlos del Rio, MD, FIDSA
The good news is that we are seeing a decline. The bad news is that it is not much of a decline. We still have a lot of infections in this country and we are nowhere close to ending transmission. Some places like New York and San Francisco may be close, but in some areas of the country, like the South, and particularly among young black MSM, the epidemic is going up. So, what are the strategies that we are going to use as a nation to address the epidemic in those groups? I think right now, it is an emergency. What was missing in this presentation is that it talked about the entire United States. When you are trying to address an epidemic that is not generalized, you need to get down to the zip code level to understand what the issue is. Using these data to drive interventions into action is very important.
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