Inside This Issue: State of the U.S. HIV epidemic, acute hep C cases continue rise, $97.75-million funding opportunity from CDC, 40th anniversary of HIV, and more.
State of the U.S. HIV Epidemic
CDC Publishes Three Major Surveillance Reports on HIV in the United States
The Centers for Disease Control and Prevention (CDC) has just published three new reports: Estimated HIV Incidence and Prevalence in the United States, 2015-2019; Diagnoses of HIV Infection in the United States and Dependent Areas, 2019; and Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data – United States and 6 Dependent Areas, 2019. The reports provide the latest available information (through the year 2019) about HIV diagnoses, incidence, and prevalence, as well as progress in key HIV prevention and care measures.
AtlasPlus – CDC’s interactive tool for creating customized tables, maps, and charts from surveillance data – has also been updated to include the new HIV data. In addition, the Department of Health and Human Services has updated America’s HIV Epidemic Analysis Dashboard (AHEAD) with new data for all six EHE indicators at the national, state/territory, and county/area levels. The six indicators are HIV diagnoses, HIV incidence, knowledge of HIV status, linkage to care, viral suppression, and pre-exposure prophylaxis (PrEP) coverage.
This summary of highlights from the three recent HIV surveillance reports draws heavily on a CDC Dear Colleague Letter by Dr. Demetre Daskalakis, director of CDC’s Division of HIV/AIDS Prevention.
HIV Prevalence and Incidence: At the end of 2019, an estimated 1.2 million persons aged 13 years and older were living with HIV infection in the United States – about a 2% increase from the figure in 2015, because the number of new HIV infections exceeds the number of HIV deaths. This 1.2-million total includes the estimated 13% of persons with HIV whose infection had not been diagnosed.
“CDC estimates of annual HIV infections in the United States show hopeful signs of progress in recent years,” according to Dr. Daskalakis. Estimated new HIV infections in the U.S. declined 8% from 37,800 in 2015 to 34,800 in 2019 – largely due to significant reductions in the number of HIV infections among gay, bisexual, and other men who have sex with men (MSM). Between 2015 and 2019, the number of HIV infections among MSM fell 9% overall, and infections among young MSM 13-24 years old declined 33%. Although reductions occurred in young MSM of all races, young Black/African American and Hispanic/Latino MSM continue to be severely and disproportionately affected by HIV.
CDC notes that, compared to 2015, HIV infections were somewhat lower in 2019 among African American, Hispanic/Latino, and White persons than in 2015. Although none of these declines was statistically significant, together they contributed to an overall national-level decline.
Regionally, the South continues to be disproportionately affected by HIV, accounting for over half of the nation’s new HIV infections during 2019. The number of new HIV infections in 2019 remained fairly stable among persons who inject drugs (PWID), due likely in part to the ongoing opioid crisis, according to CDC.
HIV Diagnoses: In 2019, there were 36,901 HIV diagnoses in the U.S. and six dependent areas – a 9% decrease compared to 2015. However, trends in HIV diagnoses varied among different demographic and risk groups. In particular, the number of HIV diagnoses decreased among males and females; Blacks/African Americans; Whites; Asian Americans; people of multiple races; persons 13-24, 35-44, and 45-54 years old; and overall among MSM.
However, HIV diagnoses rose among transgender males and females, White transgender persons, and transgender persons 25-34 and 35-44 years old. HIV diagnoses also increased among American Indian/Alaska Native persons; MSM 30-34, 55-59, and 60-64 years old; and PWID overall. Notable increases in HIV diagnoses occurred among White PWID, “likely due to concentrated HIV outbreaks among this group associated with the opioid crisis,” according to Dr. Daskalakis. HIV diagnoses remained stable among persons 25-35 years old and those aged 55 years and older; Hispanic/Latino persons; Native Hawaiian/other Pacific Island persons; and MSM who inject drugs.
“Overall, these reports suggest improvements in linkage to care, viral suppression, and increased PrEP use are likely contributing to recent progress. However, the reports also signal an urgent need to expand and improve HIV prevention, care, and treatment for groups who could most benefit,” according to CDC’s Dr. Daskalakis. “Intensified efforts are particularly needed in the South and among disproportionately affected populations like transgender persons, Black/African American and Hispanic/Latino MSM, and gay and bisexual men, overall. We must also work to improve access to prevention services for people who inject drugs, a population for whom progress continues to be threatened by the nation’s opioid epidemic.”
HIV Monitoring: “Data suggest the progress seen in recent years is likely linked to increased uptake of key prevention and treatment strategies in recent years, such as PrEP and ongoing treatment and care, which are necessary to maintain viral suppression,” according to Dr. Daskalakis. These trends are encouraging although substantial gaps remain. In 2015, only about 3% of persons eligible for PrEP were prescribed it. By 2019, this figure rose to 23%, with nearly 285,000 people nationwide on PrEP. Progress also occurred on the HIV care continuum. Between 2015 and 2019, the percentage of people with newly diagnosed HIV who were linked to care within one month of diagnosis rose from 75% to 81%. Viral suppression rates similarly increased from 60% to 66% during the period. “These data are encouraging,” Dr. Daskalakis noted. “However, the nation will need to achieve 50% PrEP coverage and 95% rapid linkage to care and viral suppression to reach the goals outlined in the Ending the HIV Epidemic in the U.S. (EHE) initiative.”
New Surveillance Slide Sets: CDC has produced two slide sets that summarize selected aspects of the new HIV surveillance data:
- Estimated HIV Incidence and Prevalence in the United States, 2010-2019, summarizes trends in HIV incidence during the 2010s, with breakdowns by age, sex, race/ethnicity, transmission category, and region. Data for 2019 is also provided on knowledge of HIV status, as well as HIV prevalence in the 50 states, District of Columbia, and Puerto Rico.
- HIV Infection, Stage 3 (AIDS), 2019, summarizes trends in AIDS diagnoses and deaths from 1985 to 2019, with breakdowns by age, sex, race/ethnicity, transmission category, and region. Data on cumulative AIDS diagnoses and deaths through 2019, and AIDS data for Metropolitan Statistical Areas are also provided.
Reported Cases of Acute Hepatitis C Infection Continue Rising in the United States
CDC recently published online Viral Hepatitis Surveillance 2019, a report providing the latest full-year surveillance data for hepatitis C (HCV), hepatitis B (HBV), and hepatitis A (HAV) in the United States. During 2019, a total of 4,136 acute HCV cases were reported to CDC, corresponding to 57,500 estimated infections, after adjusting for case underascertainment and underreporting. Both the total reported acute HCV cases and estimated total acute infections have more than doubled – up 133% – since 2012 (see Figure 3.1).
This increase has been driven largely by the rapid rise in the number of cases among young adults in the 20-29 and 30-39 age groups. Between 2010 and 2019 the annual rates of reported acute HCV cases quintupled from 0.6 to 3.2 cases per 100,000 population for 30-39 year-olds, and quadrupled from 0.7 to 2.9 cases per 100,000 for 20-29 year-olds. (See Figure 3.4). Injection drug use was by far the most common HCV risk factor reported among persons with acute HCV infection during 2019. This was reported in two-thirds (67%) of the 1,952 acute HCV cases for which injection drug use information was available.
A total of 123,312 new cases of chronic HCV were also reported to CDC during 2019, corresponding to a rate of 56.7 cases per 100,000. The rate of newly reported chronic HCV was highest among persons 30-39 years old (109.1 cases per 100,000). The distribution of newly reported chronic HCV cases has two age peaks – one among persons in their late twenties to mid-thirties, and a second among persons in their late fifties to mid-sixties (see Figure 3.8). A total of 217 perinatal HCV cases were reported to CDC during 2019, the second year that states conducted standardized surveillance for perinatal HCV and reported cases to CDC.
The report includes the following figures and tables that have state-specific data for acute, chronic, or perinatal HCV: Figure 3.2, Figure 3.3, Figure 3.9, Table 3.1, Table 3.4, Table 3.5, and Table 3.7.
If you are interested in viral hepatitis highlights for 2019, check out CDC’s “At a Glance” web pages summarizing the surveillance data for HCV, HBV, and HAV, including breakdowns by age, sex, race/ethnicity, and transmission categories. In 2019, a total of 3,192 acute HBV cases were reported to CDC, corresponding to 20,700 estimated infections, after adjusting for case underascertainment and underreporting. “Rates of acute HBV remained low in children and adolescents, likely due to childhood vaccinations,” according to CDC. “However, more than half of acute HBV cases reported to CDC in 2019 were among persons aged 30-49 years.”
From 2015 through 2019, HAV incidence increased 1,325% to 18,846 reported cases, which corresponds to an estimated 37,700 acute infections. “The increase in 2019 was because of unprecedented person-to-person outbreaks reported in 31 states, primarily among people who use drugs and people experiencing homelessness,” CDC noted.
$97.75-Million NOFO for National HIV Behavioral Surveillance Activities
CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention recently posted Notice of Funding Opportunity (NOFO) CDC-RFA-PS22-2201 for its National HIV Behavioral Surveillance (NHBS). “The purpose of this NOFO is to support ongoing bio-behavioral surveillance to monitor HIV-related behaviors, detect changes over time in HIV risk behaviors among populations at high-risk for HIV infection, and to inform and evaluate HIV prevention activities,” according to CDC. The population groups focused on in NHBS are: gay, bisexual, and other men who have sex with men; persons who inject drugs; and heterosexually active persons at increased risk for HIV. “This NOFO will aim to fill gaps in knowledge regarding HIV prevention priorities among populations in geographic areas where current data are limited. Data collected will be used to improve HIV prevention, response, testing and treatment services, and reduce HIV incidence among populations at high-risk for HIV infection.” CDC expects to make about 30 awards totaling of $97.75 million over a five-year period under this NOFO. The closing date for applications is August 2.
Milestones and Commemorations
Three “Live with Leadership” Sessions Mark 40th Anniversary of HIV
On June 5, 1981, CDC reported the first cases among gay men of a mysterious illness that later become known as AIDS. As part of activities to commemorate the 40th anniversary of HIV, federal agencies are holding a series of Live with Leadership sessions hosted by Harold Phillips, chief operating officer for the U.S. Ending the HIV Epidemic initiative. These upcoming sessions are:
- A Community Dialogue: June 5th and Long-Term Survivors, on Saturday, June 5, at 2 pm EDT: This event will feature Gina Brown, community engagement manager of the Southern AIDS Coalition and Jesse Milan, president and CEO of AIDS United.
- 40 Years of HIV: Federal Leadership, on Thursday, June 17, at 1 pm EDT: Speakers at this event will include Laura Cheever, associate administrator of HRSA’s HIV/AIDS Bureau, and Dr. Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
- 40 Years of Progress: HIV Testing, on Tuesday, June 22, at 4 pm EDT: This event will feature Dr. Demetre Daskalakis, director of CDC’s Division of HIV/AIDS Prevention.
For a list of selected other activities marking the 40th anniversary of HIV, visit NEAETC’s 2021 HIV Long-Term Survivors Awareness Day page.
Online Museum Exhibit: Reflections on 40 Years of HIV
The David J. Sencer CDC Museum has created an online exhibit, Reflections on 40 Years of HIV, an extensive set of resources highlighting the agency’s role in responding to the HIV epidemic over the past four decades. These include:
- We Were There – personal experiences of individuals who led CDC investigations of HIV that shaped health care policy;
- Story of CDC: Early AIDS – an exhibit exploring CDC’s early response to the epidemic;
- HIV and AIDS Timeline – a chronicle of CDC’s role in addressing the HIV epidemic in the U.S. and worldwide from 1981 through 2020;
- Reflections on 40 Years of AIDS – the lead article in the June issue of CDC’s Emerging Infectious Diseases Journal
- Oral Histories – a series of video interviews with researchers involved in HIV research and response; and
- Global Health Chronicles – a collection of oral histories, photographs, documents, and other media representing the early years of AIDS and CDC’s response to the epidemic.
NIH Communications Campaign Highlights HIV/AIDS Milestones
From now through World AIDS Day on December 1, the National Institutes of Health Office of AIDS Research is conducting a communications campaign “to recognize the milestones achieved through science and pay tribute to more than 32 million people who have died from AIDS-related illness globally (including 700,000 Americans), and support the goal of Ending the HIV Epidemic in the U.S. (EHE) and worldwide.” The campaign includes a social media toolkit with resources from NIH and federal partners to raise awareness and spread the word about HIV and the themes of reflecting, recommiting, reenergizing, and reengaging on the 40th anniversary of HIV and the work ahead to end the epidemic. Additional resources are expected to be added in early June.
AIDSVu Blog and Infographics Spotlight HIV Among Asian Americans and Pacific Islanders
In conjunction with National Asian and Pacific Islander HIV/AIDS Awareness Day last month, AIDSVu published two blog items – one summarizing recent HIV diagnoses and trends among Asian and Pacific Islanders in the U.S., including Native Hawaiians, and the second on the impact of HIV, viral hepatitis, and health inequities on these communities. AIDSVu also produced the following updated infographics:
- Social Determinants of Health and HIV Among Asians, Native Hawaiians, and Pacific Islanders
- Percentage of New Diagnoses Among Asians, Native Hawaiians, and Pacific Islanders
- Changes in HIV Diagnoses Over Time Among Asians, Native Hawaiians, and Pacific Islanders
- Percentage of Asians, Native Hawaiians, and Pacific Islanders Who Have Ever Been Tested for HIV
Recent COVID-19 Studies in MMWR
CDC’s Morbidity and Mortality Weekly Report (MMWR) is providing continuing coverage of COVID-19-related research. CDC is archiving the MMWR reports on a page devoted to studies about COVID-19. For your convenience, we have compiled links to recent MMWR papers below:
- Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity – United States, December 14, 2020-May 1, 2021
- Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel – 33 U.S. Sites, January-March 2021
- The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Adolescents Aged 12-15 Years – United States, May 2021
- Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties – United States, December 14, 2020-April 10, 2021
- COVID-19 Vaccine Breakthrough Infections Reported to CDC – United States, January 1-April 30, 2021
- COVID-19 Testing to Sustain In-Person Instruction and Extracurricular Activities in High Schools – Utah, November 2020-March 2021
- Notes from the Field: Impact of the COVID-19 Response on Scale-Up of HIV Viral Load Testing – PEPFAR-Supported Countries, January-June 2020
- Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools – Georgia, November 16-December 11, 2020
- Characteristics of COVID-19 Cases and Outbreaks at Child Care Facilities – District of Columbia, July-December 2020