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CDC report: 80 percent of those with HIV not aware they were infected

Dr. Joseph McGowan in Manhasset on April 26,

Dr. Joseph McGowan in Manhasset on April 26, 2018. Credit: Howard Schnapp

About 80 percent of HIV infections in 2016 were transmitted by people who were unaware they carried the virus or by those who knew they were HIV positive but were not taking medication, according to a new report form the Centers for Disease Control and Prevention.

The findings, which were reported Monday, underscored the importance of HIV treatment because the virus, which can lead to full-blown AIDS, was not transmitted in 2016 by HIV-positive people who were consistently taking antiretroviral medications. Current HIV therapy is so effective, doctors said, that it can prevent transmission of the virus.

But the report, released to coincide with the opening day of the CDC’s National HIV Prevention Conference in Atlanta, revealed stark regional and demographic disparities when it comes to HIV.

More than half of HIV infections in the United States occur in Southern states, and among them, 48 counties bear the brunt of most of the viral transmission nationwide, the CDC found. Areas include those where residents are largely African-American and poor, but also include rural areas and territories, such as parts of Puerto Rico.

While New York is on track to dramatically reduce new HIV infections by the end of 2020 and put an end to the epidemic in the state, there remains pockets of transmission throughout New York, including on Long Island, where more work must be done to reach people who are infected but untreated.

“We are working with community members, people who are influencers, to get the message out about getting tested,” said Dr. Joseph McGowan, medical director of Northwell Health’s Center for AIDS Research and Training in Manhasset. He and his colleagues have mapped out HIV-vulnerable pockets on Long Island — so-called hot zones.

These areas include several largely African-American communities — parts of Hempstead, Westbury and Huntington Station, among other areas, McGowan said in a phone interview from the HIV conference in Atlanta.

For people who will not come to his center for testing or who avoid the center’s mobile unit where HIV testing is conducted, he and his colleagues are distributing screening kits, which allow a more discrete method of testing.

“If you can get people into treatment, then transmission goes down to zero,” said McGowan, as he lamented proposed cutbacks in Medicaid at both the state and federal level, which can stymie patients’ efforts to obtain and remain on treatment.

In the CDC report, released in the agency's Vital Signs publication, epidemiologists painted a statistical portrait of HIV transmission in the United States during 2016, the most recent year for complete data.

They found that 38 percent of the 38,700 people who developed HIV in 2016 contracted it from 15 percent of the people in the population who were infected but didn't know it. Another 43 percent of people who became infected that year got it from the 23 percent of people who knew they had it but were not taking antiretroviral medications.

The remaining infections were transmitted by the 11 percent of people who were diagnosed but were inconsistently on antiretroviral drugs. 

“We have an unprecedented opportunity to end the HIV epidemic in America,” said Adm. Brett P. Giroir, a physician and assistant secretary for health at the U.S. Department of Health and Human Services. “We must close these glaring gaps in HIV prevention and care, and we must start now."

In his State of the Union Address last month, President Donald Trump called for an end to the HIV/AIDS epidemic within a decade. His new federal budget, which was released last week, calls for $291 million in special HIV funding to provide resources to help reduce transmission of the virus.

CDC experts emphasized Monday that it is not only feasible to end the epidemic, but possible.

"We have the tools to end the HIV epidemic, but a tool is only useful if it's in someone's hands," Dr. Jonathan Mermin, the CDC's director of HIV/AIDS, viral hepatitis, STD and TB prevention, said in a statement.

"This is why it's vital to bring testing and treatment to everyone with HIV," Mermin added, "and to empower them to take control of their lives and change the course of the epidemic."