HIV incidence has decreased overall, but remains higher among minority men who have sex with men

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Overall HIV incidence in the United States has decreased in all high-risk transmission groups except for minority men who have sex with men (MSM).

2. Using a CD4 depletion model, higher levels of undiagnosed HIV infections were observed among minority MSM ethnic groups compared to white and older MSM.

Evidence Rating Level: 1 (Excellent)

Study Rundown: HIV remains a significant health concern globally, as well as in the United States. There are over 1 million individuals living with HIV, of which a large proportion come from high-risk populations, including men who have sex with men (MSM) from all racial/ethnic groups. The purpose of this study was to evaluate the incidence and prevalence of HIV infections in the United States, as well as to estimate the burden of undiagnosed HIV infections among MSM. The authors of the study observed that while HIV incidence has decreased overall, incidence rates remain elevated among this high-risk population. This study has several limitations. First, the detection of the primary study outcomes was dependent on the accuracy of the CD4 depletion model. Furthermore, there is the potential that CD4 data was not complete, as not all patients may have reported data to the National HIV Surveillance System or may not have had access to care. Overall, the results of the study emphasize the importance of continued efforts within the population of MSM to reduce HIV incidence and prevalence of undiagnosed HIV infections.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Global epidemiology of HIV infection in men who have sex with men

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In-Depth [cross-sectional study]: The authors of this study utilized data from the National HIV Surveillance System of the Centers for Disease Control and Prevention from 2008 to 2015 for patients aged 13 years of age and older. The authors modeled three primary outcomes: HIV incidence, prevalence and percentage of undiagnosed HIV infections. From these models, it was observed that HIV incidence has decreased in the United States from 45 00 infections in 2008 to 38 500 infections in 2015, which is a 14.8% decrease overall, among all high-risk HIV transmission groups except MSM. In contrast, there was an increase in HIV infection in Hispanic/Latino MSM by 3.1% (95% CI, 1.6% to 4.5%) per year from 2008 to 2015. Furthermore, with respect to undiagnosed HIV infections, the prevalence has decreased among MSM from 21.3% in 2008 to 16.7% in 2015, a total of 21.6% decreased overall (CI, -4.1% to -2.6%). Despite this decrease, there remains a higher percentage of undiagnosed HIV infections among minority ethnic groups compared to white and older MSM.

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