A path toward ending AIDS in the US by 2025

May 15, 2017, Brigham and Women's Hospital
HIV infecting a human cell. Credit: NIH

A new study describes an ambitious but feasible path toward what may have seemed unachievable just a decade ago: an end to the AIDS epidemic in the U.S. Using prevention surveillance data to model rates of HIV incidence, prevalence and mortality, investigators at Brigham and Women's Hospital and Johns Hopkins Bloomberg School of Public Health set targets, specifically a decrease in new infections to 21,000 by 2020 and to 12,000 by 2025, that would mark a transition toward ending the HIV/AIDS epidemic. Their findings are published in The American Journal of Preventive Medicine.

"Achieving these targets will require a sustained and intensified national commitment to ending the epidemic," said Robert Bonacci, MD, MPH, of the BWH Department of Medicine and lead author of the study. "But if the U.S. does achieve a reduction to 12,000 new HIV infections by 2025, it could mark an important turning point in the U.S. HIV epidemic: a decline in the total number of people living with HIV in the U.S., and the beginning of the end of the U.S. AIDS epidemic."

Using Centers for Disease Control and Prevention surveillance data for 2010 to 2013, the team modeled many key indicators including incidence and prevalence rates, transmission rates, death rates and more through 2025. Taking into account goals set forward by the U.S. National HIV/AIDS Strategy (NHAS), they estimated the potential trajectory of the epidemic if those benchmarks in care were met. The NHAS goals for 2020 included that 90 percent of people living with HIV would know their status; 90 percent would receive quality care; and 90 percent of people on antiretroviral therapy would achieve viral suppression (the "90/90/90" goals). Extending beyond 2020, they evaluated an achievement of those goals at 95 percent levels by 2025 (the "95/95/95" goals).

With this framework in place, the authors evaluated whether reducing new HIV infections to 12,000 by 2025 would be achievable. Using mathematical modeling, they found that the U.S. could achieve a 46 percent reduction in HIV incidence by 2020 and a nearly 70 percent reduction in HIV incidence by 2025, provided that the U.S. implements a 90/90/90 HIV program framework by 2020 and 95/95/95 framework by 2025. In addition, the HIV transmission rate, (one measure of how fast the epidemic is spreading) would decrease from 3.53 in 2013 to 0.98 in 2025; HIV-related deaths would decrease from 16,500 in 2013 to 12,522 in 2025; and the total number of people living with HIV in the U.S. would increase from 1,104,600 in 2013 to 1,220,615 in 2025.

The authors note the importance of achieving these goals across the U.S., most especially in communities that have been disproportionately affected by HIV, including gay men, young people, transgender persons, black and Hispanic Americans and those who live in southern states, and of tracking progress in real time.

"Providing HIV services to our most disproportionately affected communities is fundamental to future success," said David Holtgrave, PhD, of the Johns Hopkins Bloomberg School of Public Health and senior study author. "In an era of limited funding and competing priorities, it is critically important that we intensify our national commitment to addressing the HIV over the next decade."

Researchers report no external funding for this work.

Explore further: Number of HIV infections falling in United States, but fails to meet reduction goals

More information: American Journal of Preventive Medicine (2017). DOI: 10.1016/j.amepre.2017.03.012

Related Stories

Number of HIV infections falling in United States, but fails to meet reduction goals

May 3, 2016
The number of new HIV infections occurring annually in the United States decreased by an estimated 11 percent from 2010 to 2015, while the HIV transmission rate decreased by an estimated 17 percent during the same time period, ...

Vaccine, improved treatment are keys to control of a surging HIV pandemic

March 20, 2017
Development and widespread use of a vaccine that's even partially effective against HIV, along with more progress toward diagnosis and treatment, offer the best hopes for turning the corner on a global pandemic that's still ...

Large increases in HIV suppression needed to reduce new infections in critical population

October 20, 2016
Achieving moderate reduction of new HIV infections among men who have sex with men (MSM) will depend on significantly increasing the percentage of HIV-infected MSM whose viral load is suppressed to undetectable levels, according ...

Turning the corner on the HIV epidemic in Zimbabwe, Malawi, and Zambia

February 16, 2017
Newly released findings from national HIV surveys in Zimbabwe, Malawi, and Zambia reveal extraordinary progress in confronting the HIV epidemic. These three countries in Southern Africa have been heavily affected by HIV, ...

Findings show significant progress against HIV epidemic in Africa; 90-90-90 goals in reach

December 1, 2016
National surveys in Zimbabwe, Malawi, and Zambia reveal exceptional progress against HIV, with decreasing rates of new infection, stable numbers of people living with HIV, and more than half of all those living with HIV showing ...

Controlling the HIV epidemic: A progress report on efforts in sub-Saharan Africa

May 2, 2017
In a Research Article published in PLOS Medicine, Richard Hayes of the London School of Hygiene & Tropical Medicine, UK and colleagues report early findings from PopART—a clinical trial evaluating an intervention to achieve ...

Recommended for you

Proof-of-concept HIV immunotherapy study passes Phase 1 safety trial

September 21, 2018
Preliminary results from a phase I clinical trial have demonstrated the safety and tolerability of a cell therapy involving the ex vivo expansion of T cells and their subsequent infusion into HIV-infected individuals previously ...

FRESH program combines basic science with social benefits for women at risk of HIV

September 14, 2018
A program established by investigators from the Ragon Institute of Massachusetts General Hospital (MGH), MIT and Harvard is addressing the persistently elevated risk of HIV infection among young women in South Africa from ...

New study finds HIV outbreak in Indiana could have been prevented

September 13, 2018
An HIV outbreak among people who inject drugs in Indiana from 2011 to 2015 could have been avoided if the state's top health and elected officials had acted sooner on warnings, a new study by the Yale School of Public Health ...

Largest study of 'post-treatment controllers' reveals clues about HIV remission

September 13, 2018
Most HIV patients need to take daily anti-retroviral therapy—if they suspend treatment, HIV will rebound within 3-4 weeks. But clinical trials have revealed that a small fraction of patients can stop taking medications ...

Very few sexually active gay and bisexual men use prophylactic drug to prevent HIV transmission, study finds

September 12, 2018
Only 4 percent of sexually active gay and bisexual men in the United States use Truvada, a highly effective medication used to prevent the transmission of HIV, according to the results of a first-of-its-kind study.

Special antibodies could lead to HIV vaccine

September 10, 2018
Around one percent of people infected with HIV produce antibodies that block most strains of the virus. These broadly acting antibodies provide the key to developing an effective vaccine against HIV. Researchers from the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.