CDC: 40 percent of PLWH transmit HIV in the US

At a press conference last Monday, the US Department of Health and Human Services (HHS) outlined a strategy to reduce by at least 90% the number of new HIV infections in the country by 2030, writes CNN.

Earlier, during the annual message to Congress, US President Donald Trump announced his intention to stop the spread of HIV in the country for 10 years. This Monday, Dr. Jerome M. Adams spoke about the four key elements of the Trump program - diagnosis, treatment, prevention, and rapid response, which have been announced earlier. The plan will target work in 48 counties and 7 states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina) with the highest HIV rates, including in rural areas. In addition to these territories, Washington (DC) and San Juan (Puerto Rico) will also receive special attention.

“HIV has cost America too much,” Adams said at a news conference on Monday.

According to him, the authorities expect to use antiretroviral therapy (ARVT), which can prevent HIV transmission during the systematic use of PLHIV, and pre-exposure prophylaxis (PrEP), which can also act as a barrier to HIV, as key tools to achieve the goal of eliminating HIV, but already from the side of people with negative status who are at risk.

“Using these medical instruments, if we can identify all those who are infected and at risk of infection, we will theoretically be able to put an end to the epidemic today,” Adams said.

He also noted that by expanding access to testing and treatment, we can prevent the “lion's share” of new infections.

“A goal that once seemed impossible to us is now achievable,” he added.

However, the therapeutic products indicated by Adams have long been used very actively throughout the United States. Why, then, has not been able to stop the spread of HIV?

According to a new report from the US Centers for Disease Control and Prevention (CDC), most new infections are transmitted only to 40% of people living with HIV - those who have either not been diagnosed or learned about their status but have not yet begun treatment.

At the same time, most people taking antiretroviral therapy can suppress viral load within six months after starting therapy. And if, in this case, they remain committed to treatment, each of them will be able to live a long and fulfilling life without posing a threat to their sexual partners.

“Today's treatment regimens are much simpler and safer [to use, - ed.] Than those that existed in the past,” the authors write, “However, despite the emergence of effective treatment, many of the 1.1 million HIV-positive people in the USA still deprived of therapy. "

According to CDC estimates, in 2016, 38,700 new HIV cases were registered in the country. To assess the relationship between the frequency of transmission of the virus and its treatment, a special model was developed by a group of CDC scientists. The data that experts used to work with her included sexual behavior and sharing of a medical instrument (needles).

Based on the analysis of the proportion of new HIV cases in specific study groups, researchers found that people who have just become infected and do not know their status have become the source of 4% of new infections.

At the same time, those who were infected for a long time and did not know their status accounted for 33.6% of new HIV cases.

People who knew about their diagnosis, but did not receive treatment, transmitted the virus in 42.6%. Those who took therapy, but did not reach an undetectable load, became “transmitting” in 19.8% of cases.

Finally, people living with HIV and having an undetectable viral load did not have a single case of a new infection.

Overall, about 15% of people with HIV had an undiagnosed infection, while almost a quarter (about 23%) knew about the diagnosis but did not receive help. Just over 1 in 10 people living with HIV (11%) received therapy, but have not yet suppressed the virus.

“In the future, increasing the proportion of people with HIV who have reached an undetectable viral load and do not transmit HIV will be critical to ending the HIV epidemic in the United States,” the authors write.

Proper care and treatment can suppress the virus and prevent new infections.

Dr. Annalie Brinks, an assistant professor of epidemiology and biostatistics at the University of Michigan, said the report’s data “underscores the critical but still little-known factor in HIV prevention, which is that suppressing the viral load among people with HIV infection, can prevent transmission. ”

Dr. Brinks, who did not participate in the study, emphasized in this regard that, despite the findings, “significant barriers” still exist in the United States for prescribing treatment and ongoing care. It can also “seriously affect” 

medical plans to “achieve the goal of 100% suppression of the virus,” she said.

“Stigma, discrimination and distrust of the medical system” are all barriers to treating and suppressing the viral load, Brinks continues.