Closing Treatment Gaps Critical for Ending HIV Epidemic in United States

Targeted treatment interventions for populations with low levels of viral suppression, paired with tailored prevention packages, will be essential to ending the HIV epidemic in the United States, say researchers.

Closing treatment gaps through targeted treatment interventions is crucial to ending the HIV epidemic in the United States, according to researchers.

It’s been 4 years since the Joint United Nations Program on HIV/AIDS and partners unveiled the “90-90-90” targets for ending the HIV pandemic. They challenged countries worldwide to diagnose 90% of people living with HIV, have 90% of those diagnosed on antiretroviral therapy (ART), and achieve viral suppression in 90% of those being treated.

Viral suppression has become one of the most sought-after goals in HIV following research showing that viral suppression means no transmission. This has led to the concept known as “treatment as prevention.” Since these ambitious goals were set in 2014, countries have struggled to meet them, but that is not to say that there hasn’t been significant progress.

To read more on efforts to end the HIV pandemic, click here.

This month, researchers unveiled their findings showing that between 1997 and 2015, viral suppression rates nearly tripled, demonstrating that the emergence and uptake of ART has a positive impact on not only lifespan, but also all viral suppression.

The study relied on data from 8 Centers for AIDS Research Network of Integrated Clinical Systems (CNIS) throughout the country. Among the 32,000 people studied, viral suppression rates jumped from 32% in 1997 to 85% in 2015. Over the same period, time to viral suppression dropped from 9 months to 2 months.

Notably, the study also put a spotlight on disparities among young people and black people.

“As guidelines have changed, therapies have improved, and other efforts have been instituted to improve care, the rates of viral suppression have continued to increase proportionately for all racial groups,” wrote researchers in an editorial in response to the study. “However, the likelihood of black race being associated with a detectable viral load compared to other racial groups persists; this should be investigated, and tailored interventions should be considered.”

They add that identifying and understanding disparities in achieving viral suppression is the first step toward implementing targeted interventions. One of the biggest barriers to viral suppression is engaging people in care. As CNIS is limited to patients enrolled in care—defined as those who have attended at least 2 clinic visits—when accounting for all 1.1 million people in the United States living with HIV, viral suppression rates drop down to 51% in 2015.

One strategy with promising results is the RAPID (Rapid ART Program Initiative for HIV Diagnoses) program, pioneered by the University of California, San Francisco. The program has demonstrated that by initiating therapy on the day of diagnosis, there are significant improvements in patient retention and viral suppression.

Reference

Marston H, Dieffenbach C, Fauci A, et al. Ending the HIV epidemic in the United States: closing the implementation gaps [published online August 21, 2018]. Ann Intern Med. doi: 10.7326/M18-1944.