November 30, 2016
|Top 10 Clinical Developments of 2016|
|1. Donald Trump||6. Return of the Antibodies|
|2. Switch Frenzy||7. Is an Unexpected Low HIV RNA Level Real?|
|3. 2-Drug ART||8. Dolutegravir and the Central Nervous System|
|4. Is HIV PrEP at a Tipping Point?||9. TAF in Hepatitis B|
|5. Start ART Now||10. New HIV infections in U.S. Are Down -- a Bit|
For many years, we have been told that the annual number of new diagnoses of HIV infection in the U.S. has remained fixed at around 50,000 people. And, that 50K stat has hung around the necks of all who are dedicated to HIV prevention, weighing on them and sometimes forcing back-to-the-drawing-board planning to beat down the stubborn incidence of HIV. This year, the Centers for Disease Control and Prevention (CDC) released new figures that indicate a 19% drop in new HIV diagnoses from 2005 to 2014. Moreover, for women, the decline was 40% with the greatest drop among African-American women (42%).
However, before we all start popping corks in celebration, the report also had some sober news. HIV diagnoses actually increased among men who have sex with men (MSM), especially those who are Latino or African American (Asian-American and American Indian/Alaska Native MSM also saw large upticks in new HIV diagnoses, but the absolute number of cases in these groups was relatively small). Younger MSM of all races and ethnicities drove the increases reported. Mildly reassuring was the finding that, over the most recent years, the rate of increase in HIV detection among African-American MSM appeared to be slowing, including among younger men in this category.
The CDC report also looked at geographic disparities in the epidemic. It is a pitiful picture. Southern states account for 44% of all people living with HIV, despite accounting for about 37% of the U.S. population. Further, the death rate among HIV-positive people in the U.S. South is three times that of people living in other states. In general, the deeper the South you go, the worse the death rate for HIV-infected people. The same regional trend, not surprisingly, holds for the proportion of infected people unaware of their diagnosis.
That 10,000 fewer people are now being diagnosed with HIV is super awesome and is likely due to a combination of the earlier initiation of antiretroviral therapy (ART) (thus preventing transmission), more forgiving ART to keep people suppressed and some uptake in pre-exposure prophylaxis (PrEP). The news is welcome and means that something seems to be finally working.
Of course, that something is not working equally for everyone, and the data are clear that, once again, it is the U.S. South that is lagging. It is difficult to know where to begin when reacting to yet another map that has the southern states shaded with badness. Almost the same pattern can be found on maps that indicate incarceration rates, male-female imbalance, voting rights denial for those with criminal records, lack of Medicaid expansion -- and, of course -- maps that show which states vote blue and which vote red. The road to further reducing new diagnoses of HIV infection runs through Dixie, and if this region's now emboldened political leadership resists expanding HIV testing, providing ART to those in need and funding care and services for people living with HIV, there it will meet a very dead end.
What are some other top clinical developments of 2016? Read more of Dr. Wohl's picks.
David Alain Wohl, M.D., is a professor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill, director of the North Carolina AIDS Training and Education Center and site leader of the University of North Carolina Chapel Hill AIDS Clinical Research Site.
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