Path to end HIV could be within reach for United States in next decade

The researchers say their findings reveal that, with adequate commitment, a path exists to eliminate domestic HIV infection through the achievement of critical milestones -- specifically, the reduction of annual new infections to 21,000 by 2020 and to 12,000 by 2025. They say that if these goals were met, 2025 could be the turning point for the epidemic, when HIV prevalence, or the total number of people living with HIV in the United States, would start to decline. The report is published May 15 online in the American Journal of Preventive Medicine.

"While these targets are ambitious, they could be achieved with an intensified and sustained national commitment over the next decade," says study co-author David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Bloomberg School. "It's critical to note that the key to ending the HIV epidemic domestically lies in our collective willingness as a country to invest the necessary resources in HIV diagnostic, prevention and treatment programs."

For their study, the researchers used HIV surveillance data published by the Centers for Disease Control and Prevention (CDC) for the years 2010 to 2013 to project yearly estimates for several key indicators -- the number of new infections occurring annually, the number of people living with HIV in the United States, and the mortality rate -- for 2014 through 2025.

The researchers used these projections to forecast the potential trajectory of the epidemic if the United States were to achieve certain benchmarks set by the National HIV/AIDS Strategy (NHAS), which was first released by President Obama in 2010 and updated in 2015 with targets to be met by 2020. The NHAS targets for 2020 include a"90/90/90" goal, which proposes that by 2020, 90 percent of people living with HIV will know their HIV status; 90 percent of people diagnosed with HIV will receive sustained, quality HIV care; and 90 percent of people on antiretroviral therapy (ART) will achieve viral suppression, or an undetectable level of virus in the blood. For their projection of the potential course of the epidemic from 2020 to 2025, the researchers proposed a "95/95/95" goal and assessed achievement of the NHAS targets at 95 percent levels by 2025.

Their analysis revealed that if the NHAS targets -- "90/90/90" for 2020 and "95/95/95" for 2025 -- were achieved, the number of new HIV infections in the United States would drop from 39,000 in 2013 to approximately 20,000 in 2020, or a 46 percent decrease, and to about 12,000 in 2025, a nearly 70 percent reduction. Additionally, the total number of deaths among people living with HIV would decline from 16,500 in 2013 to approximately 12,522 in 2025, a 24 percent decrease, and the mortality rate would drop from 1,494 deaths per 100,000 people living with HIV in 2013 to around 1,025 in 2025, a 31 percent decrease.

"If the United States were to reduce the number of new HIV infections to 12,000 by 2025, this would mark an important inflection point in the HIV epidemic in this country," says study leader Robert Bonacci, MD, MPH, a resident physician in the Department of Medicine at Brigham and Women's Hospital. "It would be the first year that the number of new infections drops below the simultaneously decreasing number of deaths among people living with HIV. This is critical, because if new infections decline faster than the number of deaths, the total number of people living with HIV in the United States would begin to decrease, meaning the United States would be on course to end the epidemic."

Advancements in antiretroviral therapy (ART) -- the lifesaving drugs that reduce HIV transmission by lowering the level of virus in the blood -- mean that HIV can now be a manageable chronic disease. In the United States, the average life expectancy for people living with HIV continues to increase toward that of the general population. Yet, of the more than one million people living with HIV, many lack access to ART.

Additionally, certain populations -- particularly gay men, young people, transgender people, black and Hispanic Americans and those who live in southern states -- continue to be disproportionately affected, and the overall progress has not been felt equally across all communities.