Most Americans With HIV Aren't Treated

By Kimberly Leonard

Only 3 in 10 people with HIV have the virus in check. Young people have the worst results.

A community health educator administers a free oral HIV test in Washington, D.C. on Feb. 7, 2013. Fewer than half of 18- to 24-year olds with HIV have been diagnosed, according to the CDC. 

Young American adults with HIV are the least likely age group to have the virus under control, with only 13 percent receiving medications that suppress the virus that causes AIDS, says a new study by the Centers for Disease Control and Prevention.

The researchers, who used data from 2011, note that just fewer than half of 18- to 24-year olds with HIV have been diagnosed, which they say underscores the need for more HIV testing in this population.

“It’s alarming that fewer than half of HIV-positive young adults know they are infected,” Dr. Eugene McCray, director of CDC’s Division of HIV/AIDS Prevention, said in a statement.  “Closing that gap could have a huge impact on controlling HIV – knowing your status is the first critical step toward taking care of your own health and avoiding transmission to others.”

HIV, or the human immunodeficiency virus, kills or damages the body's immune system cells, which protect people against diseases. HIV is spread most often through unprotected sex with an infected person, but can also be spread by sharing drug needles or through contact with the blood of someone who is infected. Women can also give it to their babies during pregnancy or childbirth. The most advanced stage of infection with HIV is AIDS, or acquired immunodeficiency syndrome. When not treated, the virus can be fatal. 

But people who are infected and take antiretroviral medications can suppress the virus, allowing them to live a normal lifespan and reducing the risk of transmission to others. Treatment has been shown to reduce sexual transmission of HIV by 96 percent, and U.S. clinical guidelines now recommend that everyone diagnosed with HIV receive treatment at the time they are diagnosed. 

Medical care and antiviral medications help people live longer. 

CDC considers the virus to be an epidemic, and Dr. Tom Frieden, director of the CDC, calls it a "very significant health threat." One million people live with the disease in the U.S., and 50,000 more are infected each year. Other than helping individuals infected with the virus live healthier lives, treatment greatly reduces HIV transmission, Frieden says.

Results from the study were grim for the general population. Just 30 percent of Americans with HIV had the virus under control in 2011, and approximately two-thirds of those whose virus was out of control had been diagnosed but were no longer receiving care. 

Care for people with HIV/AIDS

The Vital Signs report, published Tuesday by the CDC, did not find statistically significant differences in viral suppression by race or ethnicity, sex or risk group. "This is encouraging and reflects a strong national effort," says Dr. Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

The efforts are an essential component of the National HIV/AIDS Strategy, launched in 2010.  Key goals of the strategy include reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities.

A key finding in the study shows treatment increases with age. The percentage of those who had the virus under control: 

• 23 percent among those aged 25-34 
• 27 percent among those aged 35-44
• 34 percent among those aged 45-54
• 36 percent among those aged 55-64
• 37 percent among those aged 65 and older

“There is untapped potential to drive down the epidemic through improved testing and treatment, but we’re missing too many opportunities,” Mermin said in a statement. "Treatment is crucial.  It is one of our most important strategies for stopping new HIV infections."

In 2011, it was found that 40 percent of people living with HIV received regular HIV medical care, and that 37 percent of people living with HIV are prescribed HIV medications. 

Across ages, of those receiving medical care for HIV, 92 percent are prescribed HIV medications and 76 percent achieve viral suppression. 

About 14 per cent of people who have HIV do not know it because they have never been diagnosed. 

Among the nearly 840,000 people who had not achieved viral suppression, the following data were released:

• 66 percent had been diagnosed but were not engaged in regular HIV care
• 20 percent did not yet know they were infected
• 4 percent were engaged in care but not prescribed antiretroviral treatment
• 10 percent were prescribed antiretroviral treatment but did not achieve viral suppression 

Mermin says some people have difficulty getting the care they need because they do not know where to go or have trouble accessing care. Others have life circumstances, such as poverty, homelessness or substance abuse, that make it difficult to seek HIV care and testing, he says. 

Abstinence is the only certain way to get rid of the risk of HIV, Frieden says, but reducing the number of sexual partners can also reduce the rate. 

"For people living with HIV, it’s not just about knowing you’re infected – it’s also about going to the doctor for medical care,” Frieden said in a statement  “And for health care facilities, it’s not just about the patients in your care – it’s every person diagnosed, and every person whose diagnosis has not yet been made. Key to controlling the nation’s HIV epidemic is helping people with HIV get connected to – and stay in – care and treatment, to suppress the virus, live longer and help protect others.”