While at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston last week, Dr. Rich Wolitski, Acting Director of the HHS Office of HIV/AIDS and Infectious Disease Policy, had an opportunity speak with Dr. Jono Mermin, Director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, about highlights of some of CDC’s presentations at the conference.
CDC Estimates Lifetime Risk of Acquiring HIV Infection
Their first conversation focused on the first-ever national estimates of the lifetime risk of an HIV diagnosis for several key populations at risk and in every state. Overall, important progress has been made, but stark disparities among several disproportionately impacted populations are evident.
There has been a 20% reduction since 2005 in the estimated lifetime risk of people in the U.S. acquiring HIV and getting diagnosed. But the new CDC analysis underscored substantial disparities in HIV risk persist, particularly among gay, bisexual and other men who have sex with men (MSM)—especially MSM of color. If current HIV diagnoses rates persist, the study projected that about 1 in 2 black men who have sex with men (MSM) and 1 in 4 Latino MSM in the U.S. will be diagnosed with HIV during their lifetime. The estimates also highlight disparities among Black women and people who live in states in the South.
Dr. Mermin observes that these outcomes, while based on diagnosis trends, are not inevitable. The data, he noted, are a “clarion call” for improved progress across the nation so we can avoid the projected outcomes. Drs. Mermin and Wolitski discuss the fact that there are more HIV prevention tools available than ever before and that more widespread and regular use of these tools can prevent these estimates from becoming a reality.
Modeling Study Estimates 185,000 HIV Infections Could Be Averted in U.S. by Expanding Testing, Treatment & PrEP
Their second conversation covered another CDC study presented at CROI found that reaching the National HIV/AIDS Strategy (NHAS) targets for HIV testing and treatment and expanding the use of daily Pre-Exposure Prophylaxis (PrEP) could prevent an estimated 185,000 new HIV infections in the United States by 2020 – a 70 percent reduction in new infections. The study illustrates that expanding the use of these existing, effective HIV prevention and treatment tools can help us make significant strides toward our goal of an AIDS-free generation.
Dr. Wolitski described the study as “a ray of hope.” Dr. Mermin observed that the most impactful thing that can be done to achieve these goals is increase the number of Americans living with HIV who achieve and sustain viral suppression. Critical steps in doing so are continuing to increase the proportion of people living with HIV who are diagnosed, followed by helping people living with HIV to stay in care and on life-extending treatment.
Lessons from an Outbreak of HIV and HCV Infections in Southern Indiana
Finally, Drs. Mermin and Wolitski discussed a CROI plenary session by CDC’s Dr. John Brooks which reviewed lessons learned from a 2015 outbreak of HIV and hepatitis C in Scott County, Indiana, that was fueled by injection drug use (IDU) of prescription opioids.
Between January 2015 and February 2016, 188 new HIV diagnoses had been reported in the county, which had previously seen less than 1 HIV diagnosis per year in the prior decade. In fact, according to amfAR, [PDF 388 KB] Scott County reported more HIV diagnoses among people who inject drugs (PWID) in five months last year than New York City had recorded for PWID over a full year. More than 90% of the individuals were coinfected with hepatitis C. Dr. Mermin discusses elements of the comprehensive and rapid response that helped get control of the outbreak and halt further new infections. Among the elements of this response were providing social services and signing people up for health insurance; initiating a Syringe Services Program, providing HIV and HCV testing and linkage to care, and offering medication-assisted therapy for those experiencing drug addiction. The lessons from the Indiana can be useful to other communities vulnerable to a similar outbreak in both working to prevent a similar occurrence and preparing to respond in the event of an outbreak.
(View Dr. John Brooks’ presentation, The Evolving Epidemiology of HIV Infection in Persons Who Inject Drugs: Indiana 2015 . Read the related CDC Health Advisory “Outbreak of Recent HIV and HCV Infections among Persons Who Inject Drugs.”)