1 in 4 have HIV infection under control
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Only slightly more than one-quarter of Americans infected with the AIDS virus are getting the form of medical care that maximizes their life expectancy, according to a new estimate.
The goal of AIDS treatment is to suppress growth of HIV until the virus is no longer detectable in the bloodstream. Only 28 percent of the 1.2 million people living with HIV in the United States have their "viral load" controlled to that optimal degree, epidemiologists at the Centers for Disease Control and Prevention reported Tuesday.
"We have substantial work ahead to fully realize the benefit of treatment in the United States," Thomas R. Frieden, CDC's director, said in a press briefing two days before World AIDS Day, which is Thursday.
"It is time to act even more aggressively," said Jonathan Mermin, the agency's director of HIV/AIDS prevention.
The estimate encompasses the experience of the entire HIV-positive population, including people who don't know they are infected and those who can't get or don't want medical care.
For people enrolled in treatment, the fraction with a fully suppressed viral load is much higher and more encouraging -- about 77 percent.
The CDC is emphasizing the low overall percentage of people who have achieved the goal of full viral suppression as a way to emphasize how much remains to be done 30 years into the AIDS epidemic. The agency in recent years has endorsed universal HIV testing of Americans, and urged physicians and health departments to make sure that people found to be infected get treatment.
About 80 percent of Americans with HIV know they are infected.
About 20 percent are unaware -- a situation that, studies have shown, makes it much more likely they will transmit the virus to others.
Slightly more than 75 percent of people are "linked to care" within four months of receiving their diagnosis, but only 50 percent stay in care.
The CDC analysis did not address why so many people with HIV infection stop treatment.
However, many diseases have high rates of attrition from treatment, with reluctance to take pills, drug side effects, inconvenience, expense and denial all being reasons.
Of people remaining in care, 89 percent were prescribed antiretroviral therapy, which consists of three or more drugs that prevent the virus from replicating.
Of that group, 77 percent had a fully suppressed viral load the last time they were tested.
In the United States, the average person survives about 11 years after becoming infected with HIV if the infection is not treated. (Survival is shorter in many developing countries.) How long people can expect to live with optimal treatment is uncertain, although it appears to be decades.
A study published this month projected that a man who acquired HIV through homosexual intercourse at age 30 and starts treatment before significant damage to his immune system has a life expectancy of 75 years.
The infection would be responsible for the loss of about seven years of life, which the researchers said was comparable to the effects of cigarette smoking.
Earlier studies have estimated a somewhat greater loss of longevity from HIV infection.
Most projections show that people who don't start treatment until they've suffered immune damage will have shorter lives.
The new report, published in CDC's Morbidity and Mortality Weekly Report, is based on various projects that monitor HIV testing, patient behavior and treatment success around the country.
The data reveal significant differences by age, sex and ethnic group.
For example, 76 percent of HIV-positive people age 18 to 24 who are in medical care are prescribed antiretrovirals, compared with 92 percent of people age 55 and older.
Ninety-two percent of whites are prescribed the drugs, compared with 89 percent of Hispanics and 86 percent of blacks. Eighty-four percent of whites achieve full suppression of viral load in their bloodstreams, compared with 79 percent of Hispanics and 70 percent of blacks.
Slightly fewer women (86 percent) than men (90 percent) are prescribed antiretroviral therapy, and slightly fewer women (71 percent) than men (79 percent) achieve viral suppression.
A survey of care in 23 different areas around the country found that only 45 percent of HIV patients reported having been counseled in the previous year about ways to lower their risk of transmitting the virus to others. The rate of counseling was higher in young people than old, and higher in blacks and Hispanics than whites.
On Tuesday the CDC also announced a five-year, $359 million annual round of funding to health departments in state and city health departments where HIV infection is most prevalent.
Three-quarters of each grant must go to specific programs that refer newly diagnosed patients to medical treatment and help keep them there.
The CDC also announced a $2.4 million campaign to urge young black gay men to get tested for HIV, as they are the risk group in which infection rate is still rising.
First Published November 30, 2011 12:00 am