Treatment Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents: An Update
HIV/AIDS Demographics in U.S.
Of the more than 1.2 million people aged > 13 years in the U.S. living with HIV, about 1 in 8 are unaware of their infection.30 The Centers for Disease Control and Prevention (CDC) estimates that about 50,000 people are newly infected every year.31 Men who have sex with men (MSM) are the group most impacted by HIV, and African American MSM are disproportionately represented. Although MSM were only about 4% of the U.S. male population in 2010, 78% of the newly diagnosed HIV infections among males were in MSM (63% of all new HIV infections).32,33 The groups at greatest risk of HIV infection are now young black and Latino MSM aged 13 to 24 years.33 Decreasing the rate of new HIV infections in this high-risk population remains challenging.
Across the U.S., the HIV epidemic continues to disproportionately impact southern states. An estimated 44% of all people living with HIV in the U.S. reside in the District of Columbia and in 16 southern states.34 Among the 10 states with the highest death rate for persons diagnosed with HIV, 7 are southern states–Louisiana, Alabama, Mississippi, South Carolina, Kentucky, and Maryland.35,36 The HIV epidemic in southern states is not confined to urban centers but instead extends across rural areas that have limited access to adequate health care and high rates of poverty.37
HIV Care Continuum
In July 2013, President Obama established the HIV Continuum Care Initiative directing federal departments to accelerate efforts and direct resources to increase the proportion of HIV-infected persons successfully receiving care in each stage of the continuum as part of the National HIV/AIDS Strategy.38,39 In November 2014, the CDC released a report on HIV in the U.S. that found about 14% of those with HIV infection have never been diagnosed, and only 40% are receiving HIV medical care.40 Despite the much improved and simplified ART regimens, only 30% of those living with HIV infection in the U.S. have achieved viral suppression. The CDC has outlined 4 steps for achieving viral suppression, the ultimate goal of all HIV treatment (Table 2).41
In the U.S. and Canada, a person diagnosed with HIV aged 20 years who adheres to a HIV ART regimen has a life expectancy of 71 years. The same person not taking ART has a dramatically shortened life expectancy of 32 years.42 The successful implementation of ART can help those living with HIV to enjoy an average life expectancy no different from that of persons without HIV infection.
The Future of the HIV/AIDS Epidemic
In 2014, the Joint United Nations Program on HIV/ AIDS estimated that 35 million people were living with HIV/AIDS and that 13 million were receiving ART globally. Three of 5 people with HIV infection, about 22 million, did not have access to ART. Less than one quarter of HIV-infected children are on ART.43 Changing the course of the HIV/AIDS pandemic in the U.S. and worldwide is within reach, and the new HSS and WHO guidelines provide an evidence-based framework to alter this course. Significantly expanding screening for HIV and ensuring treatment access
for all persons diagnosed with HIV as well as appropriate provision of pre-exposure prophylaxis would irrevocably alter the lives of the millions of people living with HIV/AIDS and others in their communities. It remains to be seen whether the goal to eliminate AIDS by 2020, set in both the National HIV/AIDS Strategy and the UN global commitment will be achieved.
