Most US Patients With HIV Do Not Have Virus Under Control Interview with:
Heather Bradley, PhD
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

Medical Research: What is the background for this study? What are the main findings?

Dr. Bradley: The key to controlling the HIV epidemic is controlling the virus. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Yet, only one-third of the 1.2 million people with HIV in the U.S. have the virus under control. Among those who did not have the virus under control, approximately two-thirds had been diagnosed but were not in HIV medical care.

Young people were least likely to have the virus under control. Only 13 percent of 18 – 24 year olds were virally suppressed, primarily because half don’t know they are infected. To close this gap among young people, increased HIV testing is critical.

The study did not find statistically significant differences in viral suppression by race or ethnicity, sex, or risk group.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bradley: The report underscores the importance of making sure people with HIV receive ongoing care, treatment, and other information and tools that help prevent transmission to others, as well as the need to reach more people with HIV testing. HIV care and treatment work, not only to improve health and prolong lives, but also to prevent transmission to others. By expanding access to care and treatment, we will save lives and help put an end of HIV in this country. Treatment is one of our most important strategies for stopping new HIV infections.

Health care providers play a critical role in testing and diagnosing patients, getting and keeping people with HIV in medical care, prescribing medicines, and helping patients achieve viral suppression. Everyone should begin care and treatment as soon as they are diagnosed with HIV, and keep seeing a doctor regularly, to ensure their virus is kept in check. In addition, everyone should get tested for HIV at least once, as part of routine health care, and those at higher risk should get tested more often. Health providers can also help link their patients to supportive services – like nutrition and mental health services – that can help them to stay in care and on medications.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bradley: The percentage of people with HIV who achieved viral suppression in 2011 (30 percent) was roughly stable compared to 2009 (26 percent). But it’s important to keep in mind that these data are from 2011, and a lot has changed since then. For example:

o The definitive research showing that treatment greatly reduces HIV transmission was published in August 2011.

o In 2012, U.S. clinical guidelines were revised to recommend treatment for all people living with HIV – regardless of CD4 cell count or viral load.

o In 2013, the U.S. Preventive Services Task Force recommended routine HIV screening for all adolescents and adults.

o And also in 2013, the waiting list for the AIDS Drug Assistance Program was reduced to zero.

So there are reasons to be optimistic that we have made new progress in recent years. We will continue to monitor access to testing, care, and treatment over time.


Vital Signs: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV — United States, 2011

MMWR Weekly

November 28, 2014 / 63(47);1113-1117