Only 28% of HIV patients have condition under control
■ Most Americans with the disease don't think they need ongoing treatment, or don't know they have it. Physicians can help with increased testing.
By Christine S. Moyer — Posted Dec. 12, 2011
During the early 1980s, it was common to see people in the late stages of AIDS who were emaciated and had purple lesions on their faces, said Victoria Sharp, MD.
Today, due to medical advancements, few people die of the disease and many with HIV can live to old age as long as they take their medication properly, HIV/AIDS experts say.
Yet recent Centers for Disease Control and Prevention data show that many Americans with HIV do not have their condition under control.
Of the nation's nearly 1.2 million people with the illness, only 28% have a suppressed viral load, according to a CDC study published in the Dec. 2 Morbidity and Mortality Weekly Report. A suppressed viral load improves patients' health and dramatically decreases their risk of transmitting the virus through sexual activity.
Part of the problem is that the antiretroviral treatment has been so effective that some patients do not see the need to regularly take their medication, said Dr. Sharp, director of the Center for Comprehensive Care in New York City. The center is an HIV/AIDS clinic at St. Luke's/ Roosevelt Hospital.
"It's hard for people to believe" what can happen if the virus is left untreated, she said.
At the same time, one in five Americans infected with HIV does not know he or she has the condition, the CDC said. Only about half of people diagnosed with HIV receive ongoing medical care and treatment.
To help remedy the problem, the CDC urges doctors to increase testing for HIV during routine medical visits. The agency recommends that doctors test everyone between ages 13 and 64. People at high risk of contracting the virus, including injection drug users and men who have sex with other men, should be tested at least once a year, the CDC says.
The agency encourages health professionals to educate patients on how to prevent contracting HIV. For individuals who test positive for the illness, physicians should explain that it is a chronic, lifelong condition and they should prescribe antiretroviral therapy, the CDC says.
Standard antiretroviral therapy consists of using at least three drugs to maximally suppress the HIV virus and stop the progression of the disease, according to the World Health Organization.
Taking these medications, in combination with practicing safe sex, can reduce the risk of spreading HIV by 96%, according to recent National Institutes of Health data.
A doctor's role
The CDC recommends physicians ensure that patients who are diagnosed with HIV remain in treatment.
"Increasing the proportion of Americans with HIV who have their virus under control requires all of us to be more accountable," said CDC Director Thomas Frieden, MD, MPH. "We have the tools to stop HIV from spreading in an individual patient, and we have the tools to greatly reduce its spread in communities."
Thirty years after the CDC published a report on the first known cases of AIDS, an estimated 50,000 Americans contract HIV each year and 16,000 die, according to the CDC.
For the MMWR study, researchers examined national data on the number of people ages 18 to 64 living with HIV as of June 2010 and the percentage of adults who reported being tested for the virus in the past year.
They found that in 2010, one in 10 people received a recent HIV test. The study's authors were encouraged that testing percentages were higher in states with a higher prevalence of HIV. But they said more needs to be done to meet the national HIV/AIDS strategy's goal that 90% of people infected with the virus be aware of their condition.
The strategy, issued in 2010 by the Obama administration, aims to reduce HIV infections, provide better care for patients with the condition and lessen health disparities.
The CDC's latest effort to help identify people with HIV is a national campaign, launched in November, that encourages testing among black men who are bisexual or gay. These men have an increased risk of contracting the disease, the agency said.
Black men who have sex with other males account for nearly a quarter of all new HIV infections in the U.S., said Kevin Fenton, MD, PhD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. He said young black men who have sex with other males are the only group in which the number of new HIV infections is rising in the U.S.
"HIV testing is the gateway to effective treatment, care and prevention," Dr. Fenton said.
Also key to improving care of those with the disease is funding, President Obama said. On Dec. 1 -- World AIDS Day -- he announced plans to boost spending on HIV treatment in the U.S. by $50 million. A portion of the money will go to HIV medical clinics and programs that supply HIV/AIDS medication to people who otherwise cannot afford the drugs.
"This is a global fight and one that America must continue to lead," Obama said. "We can win this fight. We just have to keep at it, steady, persistent -- today, tomorrow, every day until we get to zero [infections]."