Many people with HIV in the United States are still being diagnosed with HIV late, and therefore not getting the full therapeutic and prevention benefits of starting antiretroviral therapy (ART) early, according to the latest Vital Signs report from the US Centers for Disease Control and Prevention (CDC), released in advance of World AIDS Day.
People at risk for HIV in the US are getting tested more often than they did in the past and are living with HIV for a shorter period of time before diagnosis, CDC officials said during the media briefing on 28 November. The median time between infection and diagnosis was three years in 2015, a seven-month decline since 2011.
"If you are at risk for HIV, don’t guess—get a test," said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "The benefits are clear. Prompt diagnosis is prevention. It is the first step to protecting people living with HIV and their partners."
Effective ART prevents T-cell loss and the decline of immune function, and studies definitively show that people who are on treatment that suppresses their viral load to an undetectable level do not transmit HIV. US and World Health Organization guidelines now recommend universal treatment for everyone diagnosed with HIV.
Getting tested is the first step to starting treatment. The CDC recommends that everyone age 13 to 64 should get a routine HIV test at least once, people at high risk for infection should get tested annually and those using pre-exposure prophylaxis (PrEP) should get tested quarterly.
But HIV testing and diagnosis often does not happen in a timely manner. The CDC estimates that 15% of people living with HIV in the US do not know their status, and more than 40% of new infections are attributable to people who are unaware that they have the virus.
As described in the 28 November edition of Morbidity and Mortality Weekly Report, the new Vital Signs report says that half of the nearly 40,000 Americans diagnosed with HIV in 2015 had been living with the virus for at least three years, a quarter had been infected for seven years or more and 20% already had AIDS at the time of diagnosis.
As is typical of the HIV epidemic, the amount of time spent undiagnosed varied across demographic groups. Heterosexual men had undiagnosed HIV longer than women who inject drugs or gay and bisexual men (a median of about five years, two years and three years, respectively). Asian Americans went undiagnosed for about four years, African Americans and Latinos for about three years and whites for about two years, according to the report.
Among the groups most likely to acquire HIV, 29% of gay and bi men, 42% of people who inject drugs and 59% of at-risk heterosexuals in a multistate study said that they had not been tested in the past year. Of these, 70% reported that they had seen a healthcare provider during that time, "signaling missed opportunities" for testing," Mermin said.
"Now more than ever, we have the prevention and treatment tools to stop HIV," Mermin and Eugene McCray, director of the CDC's Division of HIV/AIDS Prevention, wrote in a letter to colleagues.
"For people living with HIV, getting a test is the first step to starting antiretroviral therapy, which can preserve their health and prevent HIV transmission to partners," they continued. "We are closer than ever to achieving a future free of HIV in the United States, and we have the prevention and treatment options to get there. But more HIV testing is needed to make sure those powerful tools are available to people who can benefit from them."
Dailey AF et al. Vital Signs: Human immunodeficiency virus testing and diagnosis delays—United States. Morbidity and Mortality Weekly Report, 2017.