Joe Barber Jr, PhD
Jun 17, 2013
Substantial differences in each step of the continuum of care for HIV exist in relation to age, according to the findings of a retrospective study.
H. Irene Hall, PhD, from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and colleagues published their findings online June 17 in JAMA Internal Medicine.
In the study, the researchers used data from the CDC's National HIV Surveillance System to determine the prevalence of undiagnosed HIV infection among people at least 13 years old, and linkage to care was estimated using data from 14 states. Among the 1,148,200 people estimated to be infected with HIV in 2009, 18% had not been diagnosed, 34% were not linked to care, 63% were not retained in care, 67% were not receiving ART, and 75% had not achieved viral suppression.
In total, 44% of HIV-infected people were black compared with 19% for Latinos and 33% for whites. No significant ethnicity or sex-related differences were noted for any steps of the continuum of care, except men who were infected with HIV through heterosexual contact. They were less likely to achieve viral suppression than those who were infected through male-to-male sexual contact (19% vs 27%; P < .04).
Compared with people aged 55 to 64 years, those aged 25¬ to 34 and 35 to 44 years were less likely to be aware of their infection or linked to care. Specifically, people aged 55 to 64 years (36%) were more likely to achieve viral suppression than those aged 25 to 34 years (15%; P < .001) or 35 to 44 years (22%; P < .001).
In addition, among people prescribed ART, adults aged 55 to 64 years (86%) were more likely to achieve viral suppression than those aged 25 to 34 years (70%) or 35 to 44 years (73%).
The limitations of the study included the use of linkage of care data for only 14 states, the use of retention of care data for only 4 months, and a lack of data for certain ethnic groups.
"Individuals, health care providers, health departments, and government agencies must all work together to increase the numbers of people living with HIV who are aware of their status, linked to and retained in care, receiving treatment, and adherent to treatment," the authors write.
In a related commentary, Katerina A. Christopoulos, MD, MPH, and Diane V. Havlir, MD, from the Department of Medicine, University of California, San Francisco, and San Francisco General Hospital, stressed that additional efforts are needed to ensure the health of all persons infected with HIV. "If we are to meet the goals of the National HIV/AIDS Strategy, then the ultimate end point to which the cascade aspires is not just the absence of viremia but the presence of health for all sectors of society affected by HIV," Dr. Christopoulos and Dr. Havlir write. "Achieving an AIDS-free generation will be within reach if, and only if, these efforts succeed."
Dr. Christopoulos receives grant support from Bristol-Myers Squibb. The authors and Dr. Havlir have disclosed no relevant financial relationships.
JAMA Intern Med. Published online June 17, 2013.