Over 90% of new HIV infections in the United States could be prevented by diagnosing those living with HIV and providing prompt, ongoing care and treatment that includes the use of antiretroviral therapy (ART), according to new research from the Centers for Disease Control and Prevention (CDC) and published in JAMA Internal Medicine.
Using a multi-step, static, deterministic model with population data from the National HIV Surveillance System and detailed clinical and behavioral data from the National HIV Behavioral Surveillance System and the Medical Monitoring Project, this analysis sought to estimate the rate and number of HIV transmissions in 2009 attributable to persons at each of the five HIV continuum steps:
- HIV infected but undiagnosed
- HIV diagnosed but not retained in medical care
- Retained in care but not prescribed antiretroviral therapy
- Prescribed antiretroviral therapy but not virally suppressed
- Virally suppressed
It was estimated that 18.1% of those living with HIV in 2009 were undiagnosed, 45.2% were aware of their infection but not retained in care, 4.1% were retained in care but not prescribed ART, 7.2% were prescribed ART but not virally suppressed, and 25.3% were virally suppressed. Those who were infected but undiagnosed and those who were HIV diagnosed but not retained in medical care are believed to have been responsible for 91.5% of the approximately 45,000 HIV transmissions in 2009 (30.2% and 61.3%, respectively).
Individuals who were engaged in ongoing HIV care, but not prescribed antiretroviral treatment, were half as likely as those who were diagnosed but not in care to transmit the HIV virus, with prescribed HIV treatment further lowering the risk of transmission to 6%.
The authors emphasize that in addition to antiretroviral therapy, HIV care should include risk reduction counseling on how to protect their partners, screening and treatment for other sexually transmitted infections, and treatment for mental health and substance use disorders.
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