HIV JournalView

Top 10 HIV Clinical Developments of 2012

December 2012

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The Cascade, the Cascade!

A review of:

U.S. Centers for Disease Control and Prevention (CDC). Vital Signs: HIV prevention through care and treatment -- United States. Morb Mortal Wkly Rep. 2011 Dec 2; 60:1618.

Engagement in HIV Care

Ideas flow easily and instantaneously in our hyper-connected, socially networked age, but some concepts split from the cacophony: They resonate clearly and singularly, spreading in a way that can only be described as viral. Ed Gardner and colleagues created such a meme in a simple graph last year, illustrating for us the proportions of those living with HIV in our midst who are (and are not) aware of their infection, engaged in care, receiving HIV therapy and achieving viral suppression. At the exhausting end of the exercise, we are left with an embarrassingly small percentage of infected folks who have achieved HIV nirvana.

Their staircase image is simple and brilliant. With each step, there is failure -- but also opportunity: Get more into care, and every bar downstream should get higher.

This year the CDC updated Gardner's original calculations, finding a slightly rosier picture and spreading the "cascade" concept far and wide.

We are now blessed and cursed with The Cascade. Experts debate whether raising the left side or the right side should be the focus of our attentions (how about the middle?). Regardless, The Cascade is an important visual totem of where we stand and what we have to do -- a visual reference that we can use to conceptualize the state of the HIV epidemic and our responses. And, it is here to stay.

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