By Michael Smith, North American Correspondent, MedPage Today
Published: June 18, 2013
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
- Note that this analysis of surveillance data demonstrated that roughly a quarter of Americans with HIV had a suppressed viral load (<200 copies/ml).
- Be aware that significant age disparities existed, with younger individuals at particular risk of not having access to care.
Younger age is a barrier to successful HIV care, researchers reported.
In an analysis of surveillance data, there were disparities by age at each step of the so-called "continuum of care," according to Irene Hall, PhD, of the CDC, and colleagues. And in the youngest group analyzed -- those ages 13 through 24 -- only 41% were diagnosed and only 31% were linked to care.
People under 45 also were significantly less likely to have suppressed HIV, the goal of antiretroviral therapy, Hall and colleagues reported online in JAMA Internal Medicine.
"Increasing the percentage of young persons diagnosed and receiving continuous care is critical to addressing HIV" in the U.S., Hall and colleagues concluded.
Previous analyses have shown that -- of the more than 1.1 million Americans with HIV -- more than 200,000 don't know it, fewer than half are in regular care, and fewer than 30% have the virus under control, Hall and colleagues noted.
To get updated estimates that would take into account variation between subgroups, they turned to 2009 data from the National HIV Surveillance System to determine HIV prevalence and the proportion linked to care.
They used the CDC's Medical Monitoring Project to discover the proportion of HIV-positive people who were retained in care, prescribed antiretroviral therapy, and achieving viral suppression.
Overall, they estimated that 1,148,200 people had HIV that year, including 18% who had not yet been diagnosed. Of the entire group, an estimated 44% were black, 19% were Hispanic or Latino, and 33% were white.
Most -- some 61% -- were 35 through 54, 7% were 13 through 24, 15% were 25 through 34, 14% were 55 through 64, and 4% were 65 or older. Men made up 76% of the population and an estimated 52% of them had infections attributed to sexual contact between men.
Hall and colleagues also reported that:
- 82% of the overall group had been diagnosed as having HIV infection
- 66% were linked to care
- 37% were retained in care
- 33% were prescribed antiretroviral therapy
- 25% had a suppressed viral load
But there were differences by age at every step the continuum of care, they reported, although not all variances reached statistical significance.
Those 25 through 34, and 35 through 44, had numerically lower rates for all aspects of care than older HIV-positive people and significantly lower rates of viral suppression (at P<0.001 for both) when compared with those 55 through 64, who formed the reference group for the analysis.
Improving participation in the HIV care continuum will require insights from the "rapidly growing" field of implementation science, commented Katerina Christopoulos, MD, and Diane Havlir, MD, both of the University of California San Francisco.
Implementation science, they argued in an accompanying commentary, will help bridge the gap between research and the real world, but finding out how to translate what works in research may not be easy.
"Put simply, we may know what works but not how to do it," they wrote.
The HIV community is already trying to find ways to overcome bottlenecks in the care continuum, they noted. "Achieving an AIDS-free generation will be within reach if, and only if, these efforts succeed," they concluded.
Hall and colleagues cautioned that the numbers on linkage to care and retention in care might be underestimates.
The study had support from the CDC.
Hall and other authors made no disclosures, according to the journal.
Editorial author Christopoulos reported financial links with Bristol-Myers Squibb.
Primary source: JAMA Internal Medicine
Hall HI, et al "Differences in human immunodeficiency virus care and treatment among subpopulations in the United States" JAMA Intern Med 2013; DOI: 10.1001/jamainternmed.2013.6841.
Additional source: JAMA Internal Medicine
Christopoulos K, Havlir DV "Overcoming the human immunodeficiency virus obstacle course" JAMA Intern Med 2013; DOI: 10.1001/jamainternmed.2013.7943.