HIV: From Prevention to Care and Treatment

HIV: From Prevention to Care and Treatment

The incidence of HIV in the United States has remained stable over the last 15 years, while the number of people living with the disease has increased by about 60%. “As more people are living with HIV, it’s important to analyze and assess our efforts to identify people with the infection and ensure that they remain on treatment,” says Stacy M. Cohen, MPH. “With effective care and treatment, individuals with HIV can live long, healthy lives.” Intriguing New Findings on HIV Diagnoses Cohen and colleagues had a study published in the December 2011 issue of Morbidity and Mortality Weekly Report that highlights the importance of identifying persons with HIV and making sure they remain in medical care and receive treatment. The investigation estimated the overall proportion of persons with HIV in the U.S. who have achieved viral suppression (see also, The Role of Demographics in HIV Clinical Outcomes). To accomplish this, the research team looked at the estimated numbers of American adults living with and diagnosed with HIV, and evaluated the percentages of those diagnosed with the infection who: Are receiving HIV care. Have been prescribed antiretroviral therapy (ART). Achieved viral suppression. Received prevention counseling from healthcare providers. Approximately 77% of people diagnosed with HIV were linked to care within 3 to 4 months of diagnosis, but only 51% were retained in ongoing care. About 89% of adults with HIV who were in care had been prescribed ART. Of these, 77% had a suppressed viral load at their most recent test (Table). Despite effective tools for HIV treatment, only 28% of all HIV-infected people had a suppressed viral load...

Extending Survival for HIV-Infected Patients

Over the past few decades, advances in antiretroviral therapy (ART) have enabled many HIV-infected patients to live longer lives. Despite these successes, substantial avoidable losses in life expectancy of HIV-infected persons persist in the United States. The factors that exert a significant impact on survival include: • Late diagnosis. • Late initiation of care. • Premature discontinuation of therapy. • Background behavioral risk factors, such as alcohol, substance abuse, and smoking, which are prevalent in individuals with HIV. Assessing Survival Losses In the November 15, 2009 issue of Clinical Infectious Diseases, my colleagues and I published a study in which we estimated survival losses related to HIV disease in the U.S. This included 1) behavioral risk factors in the absence of HIV, 2) HIV disease per se, and 3) late initiation and/or early discontinuation of life saving ART. For individuals who were not infected with HIV and had risk profiles similar to those who were infected, we found that the projected life expectancy, starting at age 33, was 34.6 years, compared with 42.9 years for the general U.S. population. These findings suggested that about 8 fewer years, or a 19% reduction, in life expectancy is due to substance abuse and other high-risk behaviors even in the absence of HIV. These losses underscore the critical importance of interventions which focus on reducing substance abuse and other high-risk behaviors. Patients infected with HIV lost an additional 11.9 years of life if they received HIV care that was concordant with guidelines (representing an additional 28% reduction). The estimated life expectancy for HIV-infected patients who initiated ART very late—when CD4 cell counts reached...