Better Care, Diagnosis Could Reduce HIV Transmissions

Making improvements in HIV diagnosis and retention in care is as important as reducing high-risk sexual and drug use behaviors in terms of cutting the number of HIV transmissions in the United States, according to new research. 

The study, led by Jacek Skarbinski, MD, medical officer at the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Virtal Hepatitis, STD and TB Prevention, found that improving the reach of healthcare—primarily to HIV-infected patients who are undiagnosed and not receiving antiretroviral therapy—could have a “significant effect” on HIV transmission rates in the U.S., the authors say.
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Primary care practitioners “should know that this is the latest in a growing body of evidence that preventing HIV infections depends on reaching people who are HIV-positive with testing, care, and treatment,” says Skarbinski. “Healthcare providers can play a critical role in each of these areas.”

Skarbinski and colleagues used national databases to determine that more than 1.1 million people in the U.S. were living with HIV in the year 2009. Among them, 207,600, or 18.1%, were infected but undiagnosed, and 45% were diagnosed but not in medical care, according to the authors, who defined “retention in care” as those diagnosed with HIV infection who had completed at least 1 visit with an HIV care provider during a single 4-month period in 1 calendar year. Patients living with HIV who are retained in medical care and have achieved viral suppression are 94% less likely to transmit HIV than HIV-infected undiagnosed individuals, the authors note.

“It’s important to recognize that HIV testing is an essential gateway to care and prevention services,” says Skarbinski, adding that this analysis revealed that one-third of new infections can be attributed to transmission from people unaware of their infections.

However, he says, “once people know they have HIV, they take steps to prevent transmission to others,” pointing to a 19% drop in the transmission rate after diagnosis found in their study.

Skarbinski recommends that healthcare providers implement CDC’s routine healthcare guidelines to ensure that all Americans between the ages of 13 and 64 are tested for HIV at least once a year as a routine part of medical care.

“The ultimate goal is to provide ongoing care and treatment so all people living with HIV can achieve viral suppression,” he says. “Healthcare providers should know that U.S. guidelines now recommend that everyone diagnosed with HIV should get treatment, regardless of their viral load count.”

The bottom line, says Skarbinski, is that improving the health of those living with HIV “is critical for both those with HIV and for those at risk for HIV.”

—Mark McGraw

Reference:

Skarbinski J, Rosenberg E, et al. Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Intern Med. 2015.