A new study describes an ambitious path toward what may have seemed unachievable only a decade ago: an end to the acquired immune deficiency syndrome (AIDS) epidemic in the United States. Using prevention surveillance data to model rates of human immunodeficiency virus (HIV) incidence, prevalence, and mortality, investigators at Brigham and Women’s Hospital and Johns Hopkins Bloomberg School of Public Health set targets––specifically, decreases in new infections to 21,000 by 2020 and to 12,000 by 2025––that would mark a transition toward ending the HIV/AIDS epidemic. Their findings were published in the American Journal of Preventive Medicine.
“Achieving these targets will require a sustained and intensified national commitment to ending the epidemic,” said lead author Robert Bonacci, MD, MPH, of Brigham & Women’s. “But if the U.S. does achieve a reduction to 12,000 new HIV infections by 2025, it could mark an important turning point in the U.S. HIV epidemic: a decline in the total number of people living with HIV in the U.S., and the beginning of the end of the U.S. AIDS epidemic.”
Using Centers for Disease Control and Prevention surveillance data for 2010 to 2013, the team modeled key indicators, including incidence and prevalence rates, transmission rates, and death rates, through 2025. Taking into account goals set forth in the U.S. National HIV/AIDS Strategy (NHAS), they estimated the potential trajectory of the epidemic if those benchmarks in care were met. In the NHAS goals for 2020, 90% of people with HIV infection would know their disease status; 90% would receive quality care; and 90% of those receiving antiretroviral therapy would achieve viral suppression (the “90/90/90” goals). Beyond 2020, the NHAS aims at achieving those goals at 95% levels by 2025 (the “95/95/95” goals).
With this framework in mind, the authors evaluated whether reducing new HIV infections to 12,000 by 2025 would be achievable. Using mathematical modeling, they found that the U.S. could achieve a 46% reduction in the HIV incidence by 2020 and a nearly 70% reduction by 2025, provided that the U.S. implements a “90/90/90” HIV program by 2020 and a “95/95/95” program by 2025. In addition, the HIV transmission rate would be reduced from 3.53 in 2013 to 0.98 in 2025; HIV-related deaths would drop from 16,500 in 2013 to 12,522 in 2025; and the total number of people with HIV infection in the U.S. would increase from 1,104,600 in 2013 to 1,220,615 in 2025.
The authors noted the importance of achieving these goals across the U.S., especially in communities that have been disproportionately affected by HIV––including gay men, young people, transgender persons, black and Hispanic Americans, and those living in southern states––and of tracking progress in real time.
“Providing HIV services to our most disproportionately affected communities is fundamental to future success,” said senior author David Holtgrave, PhD, of Johns Hopkins. “In an era of limited funding and competing priorities, it is critically important that we intensify our national commitment to addressing the HIV epidemic over the next decade.”
Source: EurekAlert; May 15, 2017.