January 1, 2013
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
The CDC has recently issued the latest report on HIV incidence (i.e., new infections) in the United States, and as always it's fascinating to review the numbers.
To start, the year-by-year estimated incidence:
2010: 47,500 (38,000 men, 9,500 women)
Nope, not much change. Will data from HPTN 052 -- published in the summer of 2011 -- eventually have an impact? I think so, as the results strongly influenced both treatment guidelines and patients' willingness to start therapy. A more pessimistic view is that the treatment-as-prevention message from 052 won't have much of an effect, since data like these show that only a minority of people with HIV are actually on successful treatment. We'll see.
This latest CDC report then highlights two important trends, one good news, one not-so-good:
The new analysis also finds two noteworthy trends among heavily affected populations: early signs of an encouraging decrease in new HIV infections among black women (21 percent decrease between 2008 and 2010), and a troubling and continuing increase in new infections among young gay and bisexual men (22 percent increase over the same time period).
In these days of fiscal cliff wrangling, I could use my taxpayer's prerogative and show you a whole slew of figures -- but these three really stand out as giving us a snapshot of who gets HIV in the United States these days:
1. Incidence in 2010 among various "risk groups" (MSM, men who have sex with men; IDUs, injection drug users):
2. Proportion of new infections by transmission category:
3. Rate of new infections by race, ethnicity, and sex:
The glass-half-full message is that HIV prevention efforts are clearly working, at least to some extent, as the prevalence of HIV -- the number living with the virus -- continues to increase, yet the incidence stays the same.
The half-empty view? The continued shift of the epidemic to younger MSM of color will make additional gains difficult, as this is a patient population that could be challenging to reach.
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.