Vital Signs: HIV Transmission Along the Continuum of Care - United States, 2016.

Zihao Li,Stephanie L Sansom,H Irene Hall,David W Purcell,Demorah Hayes

doi:10.15585/mmwr.mm6811e1

Abstract

BackgroundIn 2016, an estimated 1.1 million persons had human immunodeficiency virus (HIV) infection in the United States; 38,700 were new infections. Knowledge of HIV infection status, behavior change, and antiretroviral therapy (ART) all prevent HIV transmission. Persons who achieve and maintain viral suppression (achieved by most persons within 6 months of starting ART) can live long, healthy lives and pose effectively no risk of HIV transmission to their sexual partners.MethodsA model was used to estimate transmission rates in 2016 along the HIV continuum of care. Data for sexual and needle-sharing behaviors were obtained from National HIV Behavioral Surveillance. Estimated HIV prevalence, incidence, receipt of care, and viral suppression were obtained from National HIV Surveillance System data.ResultsOverall, the HIV transmission rate was 3.5 per 100 person-years in 2016. Along the HIV continuum of care, the transmission rates from persons who were 1) acutely infected and unaware of their infection, 2) non-acutely infected and unaware, 3) aware of HIV infection but not in care, 4) receiving HIV care but not virally suppressed, and 5) taking ART and virally suppressed were 16.1, 8.4, 6.6, 6.1, and 0 per 100 person-years, respectively. The percentages of all transmissions generated by each group were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively.ConclusionApproximately 80% of new HIV transmissions are from persons who do not know they have HIV infection or are not receiving regular care. Going forward, increasing the percentage of persons with HIV infection who have achieved viral suppression and do not transmit HIV will be critical for ending the HIV epidemic in the United States.

Highlights

Medical treatment has substantially improved the health, quality of life, and life expectancy of persons with human immunodeficiency virus (HIV) infection [1]
These findings indicate that HIV transmission can become a rare event if persons with infection can obtain treatment and achieve and maintain viral suppression
These findings provide an important scientific underpinning to the new federal initiative headed by the U.S Department of Health and Human Services (HHS) to end the HIV epidemic in the United States within 10 years [6]

Summary

Introduction

Medical treatment has substantially improved the health, quality of life, and life expectancy of persons with HIV infection [1]. Four recent studies found that viral suppression prevented sexual transmission of HIV [2,3,4,5] Together, these prospective studies found no HIV transmissions attributable to sex between HIV-discordant couples when the partner with HIV infection was on treatment and maintained viral suppression, despite documenting tens of thousands of acts of condomless sex in which the HIV-negative partner was not using preexposure prophylaxis. Today’s treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects; most persons with HIV infection can achieve viral suppression within 6 months of initiating treatment These findings provide an important scientific underpinning to the new federal initiative headed by the U.S Department of Health and Human Services (HHS) to end the HIV epidemic in the United States within 10 years [6]. Going forward, increasing the percentage of persons with HIV infection who have achieved viral suppression and do not transmit HIV will be critical for ending the HIV epidemic in the United States

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