Only 1 in 4 americans with HIV has virus under control: CDC

In a report presented Friday at the International AIDS Conference in Washington, D.C., researchers from the U.S. Centers for Disease Control and Prevention said the problem applies to patients of all ages, races and ethnic groups, but especially to young people and blacks.

"This is the first time that we have ever looked at the outcome of continuum of care across all patient groups," said CDC epidemiologist Irene Hall. "And what we found is that, overall, too few people with HIV have viral suppression." People with viral load suppression are healthy and less likely to transmit the virus to others.

"Only if we get everyone under regular care for HIV/AIDS can we recognize the full benefits of treatment and prevention," said Hall, chief of the HIV incidence and case surveillance branch in the CDC division of HIV/AIDS prevention.

For the report, Hall and her colleagues pored through 2009 data collected by the CDC, which included rates of HIV testing, patient participation in the health care system, continuity of care for HIV, treatment prescribed, and the patient's viral load status in terms of suppression.

Overall, about 82 percent of all those infected with HIV know their status, meaning that more than 200,000 Americans now infected with HIV are not aware of their condition.

Two-thirds of the nation's HIV patients do have some relationship with a care provider, the report indicates, and more than one-third (37 percent) receive continuous HIV care, while one-third are treated with antiretroviral therapy.

But just over one-third of black patients were found to have ongoing care, compared with 37 percent to 38 percent of Latinos and whites. Similarly, just a little over one in five black patients was found to have viral load suppression, compared with 26 percent of Latinos and 30 percent of whites.

Blacks infected with HIV were the least likely to find out they were infected in the first place and the least likely to get any care for HIV, Hall added.

Younger HIV patients were also much less likely than older patients to know their HIV status and to obtain routine care, Hall said.

Suppression rates were also poorer among younger patients, with just 15 percent of those aged 25 to 34 having their virus under control compared with 36 percent among those aged 55 to 64.

No significant differences were seen between males and females in terms of diagnosis, treatment or disease control.

For now, the report authors can only theorize about what lies behind these differences in HIV care.

"Our study did not look at the reasons for why people are not in care, or are not prescribed [antiretroviral therapy] or don't have viral suppression," Hall noted. "But in general we do know there are differences in access to care and in insurance status. There is also a stigma associated with [HIV], and some people might distrust the medical system."

As for young people, they may not feel at risk and may not go to the doctor as often, she added.

"The treatment options certainly are much better today than in the past, but it is still a very serious disease," she said. "And it's very important that people know their status and that people who are infected get regular care."

This is not only so they can have optimum health, she said, but also "because if we want a national strategy for prevention we do need to have people with a suppressed viral load and in care so we can stop transmission of the virus."

Chris Collins, vice president and director of public policy at the American Foundation for AIDS Research (amfAR) in Washington, D.C., said that the CDC report "sounds consistent" with previous assessments of the current HIV picture across the country.

"One in five are living with HIV and don't know it," he noted. "And many other people are estranged from the health system. They don't think they can get quality care or don't have access, and we haven't done enough outreach."

Complacency about AIDS is an obstacle to ending the disease in America, said Collins. "The science is telling us that we have the opportunity to begin to end this epidemic in America," he said. "But Americans have to realize that while we have drugs that can save lives, we have failed to get them to half of the people that need them."

More information: For more on HIV care, visit the U.S. Centers for Disease Control and Prevention.

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