40% of people with HIV transmit most new infections in the US, a new analysis says. Here's the plan to stop the spread

CNN/Stylemagazine.com Newswire | 3/18/2019, 4:04 p.m.
The U.S. Department of Health and Human Services on Monday detailed its new initiative to reduce new human immunodeficiency virus ...

By Susan Scutti, CNN

(CNN) -- The U.S. Department of Health and Human Services on Monday detailed its new initiative to reduce new human immunodeficiency virus infections in the United States by at least 90% over 10 years.

President Donald Trump called for the elimination of HIV transmissions in the United States by 2030 during the State of the Union address in February. On Monday, Surgeon General Dr. Jerome M. Adams highlighted four key elements of the HIV program -- diagnose, treat, protect and respond in more detail than previously outlined. The program will focus on the 48 counties with the highest HIV rates, as well as seven states with high HIV rates in rural areas, as well as Washington, DC, and San Juan, Puerto Rico. The states are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.

"HIV has cost America too much for too long," Adams said at a news conference on Monday. He described two successful medical tools that will be key to the program: antiretroviral therapy (ART), which can prevent transmission of HIV, and pre-exposure prophylaxis (PrEP), which can prevent transmission of HIV to those at risk of acquiring the infection.

"With these medical tools, if we can identify everyone infected and at risk, we could theoretically end the epidemic today," said Adams.

Yet both treatments are already in use throughout the United States. How, then, is HIV being spread?

Most new infections are transmitted by just 40% of people infected with HIV -- those who either have not been diagnosed or have been diagnosed but are not yet receiving care, according to the new Vital Signs report, conducted by the US Center for Disease Control and Prevention and released Monday.

Yet the majority of people taking antiretroviral therapy can achieve viral suppression within six months of starting the therapy. And, if HIV-positive people maintain suppression by continuing ART, they can live long, healthy lives while effectively posing no risk of infecting sexual partners, according to the authors of the report.

"Today's treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects," wrote the authors. "Despite the availability of effective treatment, many of the 1.1 million persons with HIV infection in the United States are not effectively treated."

Just 40% of people with HIV transmit most new infections

In 2016, an estimated 38,700 people acquired a new HIV infection.

The CDC scientists constructed a model to estimate the relationship between transmission and treatment rates during 2016. Modeling data that included sexual and needle-sharing behavior the researchers analyzed the proportion of new transmissions by specific groups.

People who have just been infected and are unaware of their status led to 4% of new infections, they found. Those longer-term infected and unaware of their status accounted for 33.6% of new infections. People aware of their status but not receiving care accounted for 42.6%. Those receiving care but not fully suppressed accounted for 19.8% of new infections.

People living with HIV who maintain viral suppression with ART contributed no new infections.