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Many still get late HIV diagnosis

by Liz Highleyman

Many people with HIV are still being diagnosed late, and therefore not getting the full treatment and prevention benefits of starting antiretroviral therapy early, according to the Centers for Disease Control and Prevention's latest Vital Signs report, released this week in advance of World AIDS Day on December 1.

"If you are at risk for HIV, don't guess - get a test," said Dr. Jonathan Mermin, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "The benefits are clear. Prompt diagnosis is prevention. It is the first step to protecting people living with HIV and their partners."

Effective antiretroviral therapy prevents T-cell loss and the decline of immune function, and studies show that people who are on treatment that suppresses viral load to an undetectable level do not transmit HIV.

In 2010 San Francisco was the first jurisdiction to recommend treating everyone living with HIV, and the city now aims to get people on treatment the same day they are diagnosed. U.S. government and World Health Organization guidelines now also call for universal treatment for everyone diagnosed with HIV.

Getting tested is the first step to starting treatment. The CDC recommends that everyone age 13 to 64 should get a routine HIV test at least once, people at high risk for infection should get tested annually, and those using PrEP for HIV prevention should get quarterly tests.

People at risk for HIV in the United States are now getting tested more often than they did in the past, and they are living with HIV for a shorter period of time before diagnosis, Mermin and CDC colleagues said at a November 28 media briefing. The median time between infection and diagnosis was three years in 2015, a seven-month decline since 2011.

"These findings are more encouraging signs that the tide continues to turn on our nation's HIV epidemic," CDC director Dr. Brenda Fitzgerald said in a statement. "HIV is being diagnosed more quickly, the number of people who have the virus under control is up, and annual infections are down."

But HIV testing and diagnosis still often does not happen in a timely manner. The CDC estimates that, nationwide, 15 percent of people living with HIV do not know their status. In San Francisco, the Department of Public Health estimates that 7 percent have not been diagnosed. More than 40 percent of new infections are attributable to people who are unaware that they have HIV, according to the CDC.

The new Vital Signs report says that half of the nearly 40,000 Americans diagnosed with HIV in 2015 had been living with the virus for at least three years, a quarter had been infected for seven years or more, and 20 percent already had AIDS, or advanced HIV disease, at the time of diagnosis.

As is typical of the HIV epidemic, the amount of time spent undiagnosed varied across demographic groups. Heterosexual men lived longer with undiagnosed HIV than women who inject drugs or gay and bisexual men (a median of about five years, two years, and three years, respectively), and people of color were diagnosed later than whites. Asian-Americans went undiagnosed for about four years, African-Americans and Latinos for about three years, and whites for about two years, according to the report.

Among the groups most likely to acquire HIV, 29 percent of gay and bi men, 42 percent of people who inject drugs, and 59 percent of at-risk heterosexuals in a multistate study said that they had not been tested in the past year. Of these, 70 percent reported that they had seen a health care provider during that time, "signaling missed opportunities" for testing, Mermin told reporters.

"Now more than ever, we have the prevention and treatment tools to stop HIV. Prompt diagnosis of HIV is prevention," Mermin and Dr. Eugene McCray, director of the CDC's Division of HIV/AIDS Prevention, wrote in a letter to health care colleagues.

"For people living with HIV, getting a test is the first step to starting antiretroviral therapy, which can preserve their health and prevent HIV transmission to partners," they continued. "We are closer than ever to achieving a future free of HIV in the United States, and we have the prevention and treatment options to get there. But more HIV testing is needed to make sure those powerful tools are available to people who can benefit from them."

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