New HIV cases continue to decline, CDC finds

  • by Liz Highleyman, BAR Contributor
  • Wednesday May 22, 2024
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Dr. Jonathan Mermin, left, director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and Dr. Robyn Neblett Fanfair, director of the CDC's Division of HIV Prevention, said new reports show the number of HIV cases in the U.S. continues to decline. Photos: Courtesy CDC
Dr. Jonathan Mermin, left, director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and Dr. Robyn Neblett Fanfair, director of the CDC's Division of HIV Prevention, said new reports show the number of HIV cases in the U.S. continues to decline. Photos: Courtesy CDC

New HIV infections in the U.S. continue to fall, with the greatest declines seen among gay and bisexual men, young people, and people living in the South, according to a set of HIV surveillance reports from the Centers for Disease Control and Prevention, released May 21. An estimated 87% of people living with HIV knew their status, and 65% of those diagnosed were on treatment and achieved viral suppression in 2022, almost unchanged from last year.

"The new HIV incidence estimates show that national prevention efforts are continuing to move in the right direction overall, although substantial disparities exist," Dr. Robyn Neblett Fanfair, director of the CDC's Division of HIV Prevention, and Dr. Jonathan Mermin, director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, wrote in a letter to colleagues. "Increases in pre-exposure prophylaxis prescriptions, viral suppression and HIV testing likely contributed to the decline."

The CDC estimates that HIV incidence fell from 32,700 new infections in 2021 to 31,800 in 2022. This number remains far above the national Ending the HIV Epidemic initiative's goal of reducing new infections to 9,300 by 2025 and to 3,000 by 2030.

Since 2018, overall HIV incidence has declined by 12%. The five-year figure is useful for discerning trends over time, especially considering that the COVID-19 pandemic disrupted HIV testing and other services in 2020. New infection numbers are estimates based on extrapolation from available data. Diagnosis numbers, in contrast, are more dependent on changes in testing. There were 38,043 reported HIV diagnoses in 2022 — a higher number than estimated incidence because some people who acquired HIV in prior years were newly diagnosed.

The five-year decline in HIV incidence was largely driven by a 30% drop among people ages 13 to 24. Incidence in all other age groups remained stable. People ages 25 to 34 account for the largest number of new infections, according to the CDC figures.

While gay and bisexual men still make up a majority (67%) of people who acquire HIV, this group also saw the largest decline in new infections. Between 2018 and 2022, new cases decreased by 10% among men who have sex with men and by 27% among gay men who inject drugs. New infections fell by 20% among white gay and bisexual men and by 16% among Black gay and bi men but remained stable among Latino men. As the Bay Area Reporter previously reported, Latino men were the only group in San Francisco in 2022 to see an increase in new diagnoses.

Meanwhile, new cases among women, heterosexual men, and non-gay people who inject drugs stayed about the same. Looking at both sexes and all transmission routes combined, Black people had by far the highest HIV incidence, but they were the only group to see a decrease — 18% — while numbers remained stable for other racial and ethnic groups.

Similarly, there were more new infections in the South than the West, Midwest, and Northeast put together, but it was the only region to see a decline, falling by 16%, while the other regions remained stable.

HIV care and PrEP

Of the estimated 1.2 million people living with HIV in the U.S., 87% had been tested and knew their status in 2022, according to one report. The Ending the HIV Epidemic target is at least 95% by 2025.

Among people diagnosed with HIV in 2022, 82% were linked to care within one month. However, just 54% were retained in care and 65% achieved an undetectable viral load that year — about the same as last year. But everyone did not benefit equally. Viral suppression rates ranged from 61% for Black people to 71% for white people. The Ending the HIV Epidemic initiative aims to raise the overall viral suppression rate to 95% by 2025.

Another report noted that HIV-related deaths declined by 25% in 2022, showing the impact of early diagnosis and linkage to care and treatment.

"While we would have liked to see improved outcomes, federal funding for CDC HIV prevention and the Ryan White HIV/AIDS care and treatment program, along with other critical programs, has remained flat for years," Carl Schmid, a gay man who is the executive director of the Washington, D.C.-based HIV + Hepatitis Policy Institute, said in a statement. "Without significant increases for care and treatment and prevention programs, including those for PrEP, sadly, we will continue to experience only small drops in the number of new diagnoses, and racial and ethnic disparities will persist. As a nation, we can and must do better."

San Francisco has done better than the nation as a whole, but the city still faces challenges. New HIV diagnoses fell slightly to 157 in 2022, according to the latest epidemiology report from the SF Department of Public Health, released last fall. This resumes a declining trend that was interrupted in 2021 as HIV testing picked back up in the wake of the COVID pandemic. An estimated 97% of people with HIV knew their status and 80% achieved viral suppression within six months after diagnosis. But people experiencing homelessness accounted for nearly one in five new diagnoses, and only about half had their HIV under control.

The CDC said it has paused its PrEP reporting "to determine the best methodology for calculating PrEP coverage, and to update PrEP coverage estimates using updated methods and sources," after a calculation error was discovered. The agency expects to resume PrEP coverage reporting in June 2025.

But it does seem clear that greater PrEP use leads to fewer new infections. At the recent Conference on Retroviruses and Opportunistic Infections, Dr. Patrick Sullivan of Emory University reported that states with the highest PrEP coverage from 2012 through 2021 saw the largest declines in new HIV diagnoses. Average PrEP coverage ranged from about 6% in the 10 states with the lowest coverage to about 16% in the 10 jurisdictions with the highest coverage. Over the same period, the HIV diagnosis rate rose by almost 2% in the states with the lowest PrEP coverage while declining by 8% in the jurisdictions with the highest coverage.

"Overall, data from these reports demonstrate that expanding the reach of HIV testing, PrEP, and treatment have been effective — but our reach must extend even further, and progress must be faster, to achieve our national goal of ending new HIV infections in the United States," Neblett Fanfair and Mermin wrote. "This requires sharpening our collective focus on efforts that address inequities and their drivers, including racism and other social and structural determinants of health, and ensuring that whole person approaches to HIV prevention, care, and treatment are brought to scale and equitably reach all people who need them to stay healthy."

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