For HIV in the USA, Not in Care Exceeds the Undiagnosed -- Solutions Welcome

July 7, 2015

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

In last week's post, I asked about two of the key components of the HIV care cascade -- the "undiagnosed" vs the "diagnosed but not in care," and which group was larger in the USA. Here are your answers as of now:

In the United States right now, which category of untreated people with HIV is bigger?

The people who read this site are a pretty knowledgeable group when it comes to issues related to HIV. This is not a blog about collecting beer steins, philosophical ruminations over baseball cards, or knitting, to cite three mentioned to me by patients over the years.

(That middle one is quite something. As is his book, if you're into that kind of thing. Which I am.)

But more than half (57%) of even this erudite readership got the question wrong -- because in the United States, those diagnosed but not in regular care greatly exceed the undiagnosed. It's by a factor of more than two-fold to one, at least if you believe the CDC data displayed in this nifty video.

In the undiagnosed, there's been progress: making HIV testing easier has resulted in a great reduction in those who have HIV but don't know it. The latest data from CDC have just been published, and we're down to just 14%. Yes, 14% is still too high -- and it's up to 25% undiagnosed in certain regions (we're looking at you Louisiana) -- but it's a vast improvement over the 30-40% estimates we were seeing 10 years ago.

And in many regions, it's now < 10%. Meaning that more than 90% of those with HIV know that they have it, and can get on treatment, prolong their lives, and stop spreading the virus to others.

Now, about that much bigger other group -- 30-40% or so of those with HIV in the USA -- who know they have HIV and aren't getting care and treatment.

What's up with that?

Solutions to this problem eagerly awaited.

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.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.

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