Transcript for CDC Telebriefing: New Vital Signs Report - How can increased HIV care and treatment prevent new infections and save lives?

OPERATOR:  Welcome and thank you for standing by.  At this time all participants are in a listen-only mode.  During the question and answer session of today's call you may press star 1 to ask a question.  Today's conference is being recorded, and Barbara Reynolds, you may begin. 

BARBARA REYNOLDS:  Thank you, Shirley.  And thank you for joining us today for the vital signs telebriefing.  Today's topic is HIV patient care and with us today are three speakers.  Dr. Tom Frieden, the director for the Centers for Disease Control and Prevention.  Dr. Jonathan Mermin.  The director of CDC's National Center for HIV AIDS, Viral, STD, and TB Prevention and Dr. Eugene McCray, the director for CDC’s Division of HIV/AIDS Prevention. All will provide opening remarks and then we'll move to your questions.  So I’d like to turn the call over to Dr. Tom Frieden. 

TOM FRIEDEN:  Thank you very much, and thanks for joining us to discuss this month's vital signs report.  Each month we focus on the latest data about one of the critical health issues facing the country and what we can do about it.  This month’s report is about HIV.  More than one million Americans are living with HIV and there are an estimated 50,000 new infections each year.  Today, our report is releasing information that less than a third of Americans with HIV had their virus under control through effective care and treatment.  Even more remarkably and in some ways -- even more disturbingly.  Among those whose infection was not under control, more than three times the proportion were no longer in care as the proportion who had never been diagnosed.  This is critically important because, one key to controlling the nation's HIV epidemic is helping people living with HIV control the virus.  The bottom line of today’s briefing is that HIV care and treatment not only worked to improve health and prolong lives, but also to prevent new infections; yet we're not reaching nearly enough people.  Most people with HIV who regularly take antiretroviral medicines achieve viral suppression.  The virus is kept under control at a very low level in the body.  People with HIV who achieve viral suppression live longer.  They live healthier and U.S. clinical guidelines recommend that everyone with HIV start treatment as soon as they are diagnosed.  And that's really consistent with the way we treat most infections.  When you have an infection, you treat it.  And that's what we now recommend for HIV, treatment is particularly important in terms of HIV because people with HIV who achieve viral suppression aren't just healthier; they're also less likely to infect others.  In other words, good care and treatment are good prevention.  But today's study shows that too many people with HIV aren't getting the treatment they need in most cases because they are not receiving ongoing HIV care.  Fortunately, once people are engaged in ongoing care, most are prescribed antiretroviral treatment and achieve viral suppression.  That's why we believe we can make the biggest health impact by accelerating progress on retention and care and that's where at CDC we are focusing much of our attention.  Thinking of it in terms of numbers, there were 840,000 Americans with HIV who didn't have their virus suppression.  That means they were at greater risk for health problems and at greater risk for spreading HIV to others.  Two-thirds of these have been diagnosed, but were not receiving medical care.  And that means that we need to do more with the health care system and with people living with HIV and aids.  For people living with HIV and aids, it's not enough to know, you also have to go to health care.  For health care systems, for doctors, for health centers, and for others, it's not enough to diagnose patients, you have to take accountability and responsibility for every patient diagnosed in your health center and for public health departments for every patient diagnosed in your jurisdiction to provide them with the most e sensitive, effective, culturally appropriate care so that they will get on to treatment, stay into treatment, live longer, live healthier, stay out of the hospital, and not infect others.  Now I’ll turn the call over to Dr. Jonathan Mermin, director of CDC's National Center for HIV AIDS, Viral Hepatitis, STD, and TB prevention.  Dr. Mermin will tell us more about today's findings. 

JONATHAN MERMIN: Thank you Dr. Frieden.  Today's report provides with us a new in depth look at HIV diagnosis, care, and treatment in the country.  CDC recently released a series of snapshots of HIV care and treatment among particular groups of Americans who've been diagnosed with HIV.  Today's study includes all Americans with HIV, including those who are undiagnosed and it allows us to compare programs across different populations incorporating diagnosis into those findings.  Of the majority of those with HIV, nearly 840,000 Americans who don't have their virus under control, 66 percent have been diagnosed, but aren't getting regular HIV medical care and that's a large gap.  Engaging and retaining people with HIV in care has to be a top priority for our national HIV response and 20 percent of people whose HIV is not under control don't even realize that they are infected.  And people who don't know they're infected can't access HIV care and treatment or take steps to protect their sexual partners.  So HIV testing is the critical first step for prevention and care.  I wanted to highlight two other findings this afternoon, first, today's vital signs report does not show statistically significant differences in viral suppression by race, ethnicity, sex, or risk group.  This is encouraging.  And reflecting strong national efforts to ensure testing and care reach those who need it most.  However, we did find striking differences by age.  More than any other group, our young people are not getting the care they need.  Among people aged 18 to 24 who are living with HIV, just 13 percent had their virus under control through effective care and treatment.  Viral suppression increased with age and highest 37 percent among people aged 65 years and older.  The low level of viral suppression among 18 to 24 is due to the fact that less than half know they have HIV.  To close the age gap in viral suppression, we will need to expand efforts to reach young adults with HIV testing.  So what does all this mean for CDC?  When I look at the data, I see challenges and a large opportunity.  There's untapped potential to drive down the epidemic to increase testing and treatment.  Getting into and staying in HIV care can be daunting; some people may not know where to go, or they have trouble accessing care.  While others have life circumstances that make it difficult.  But, if we can help all Americans living with HIV overcome barriers and keep their virus in check, not only would they be healthier, the prevention impact would be tremendous.  We would finally see the annual number of new infections drop below the 50,000 we have had in the U.S. for years, and the number of deaths among people with HIV would plummet.  Now I’ll turn it over to Dr. Gene McCray, division of HIV aids prevention to tell us a bit more about what CDC is doing to respond. 

EUGENE MCCRAY: Thank you, Dr. Mermin.  Today HIV treatment is one of our most important strategies for stopping new HIV infections.  CDC focuses on diagnosing people with HIV, linking them to ongoing care, treatment, and risk reduction programs and helping them receive regular care and adhere to medication regiments.  Here are some examples I’d like to highlight.  First, we have a series of awareness campaigns to promote HIV testing and treatment.  Most recently, we launched HIV treatment works; a campaign to encourage people with HIV to seek and stay in medical care.  Second, CDC is providing funding and support to help health departments and community-based organizations increase the number of people with HIV who were diagnosed and regularly engaged in care.  Third, we're helping health department use cutting edge disease surveillance tools to identify and follow up with people with HIV who have dropped out of care.  Fourth, CDC is conducting research on innovative ways to improve HIV testing, retention in care, and adherence to treatment.  These are just a few examples of what CDC is doing to reach those who are living with HIV.  Continued efforts to reach those at highest risk for HIV remain critical as well.  Together, with other federal, state, and local agencies, health care providers, community organizations, and people with HIV, our efforts are aimed at achieving the goal of the national HIV AIDS strategy.  This strategy is a blueprint for improving health outcomes with people with HIV and reducing health disparities.  So now I’ll turn it back to Dr.  Frieden to sum up today's -- Dr. Frieden to sum up today's findings. 

TOM FRIEDEN:  Before that, let's go to questions.  I will like to say that, i would reiterate that HIV care and treatment work not only to prevent health but to prevent transition.  And it's possible to make much more progress.  It's very clear that treatment greatly reduces HIV transmissions.  We've known that for three years.  For two years, U.S. guidelines recommended for the first time that everyone with HIV received treatment regardless of the count or viral load and in 2013, the U.S.  preventative services task force had adults making it a covered health service without co-payment.  Under the affordable care act, and also in 2013, the waiting list for the aids drug assistance program was eliminated.  So there are plenty of reasons to be hopeful, and i think anyone who tests positive with HIV can now receive medical care and take advantage of the effective treatment options, and i found the findings from today's study so remarkable that we need to do better in diagnosing HIV three times as many people who don't have their virus, viral load suppressed have been diagnosed, but are not in care.  It's so important that people get tested, and that when people are positive, they start care, stay on treatment, and achieve viral suppression.  Because that's how we can stop HIV and now I’ll turn it back over to Barbara Reynolds for questions. 

BARBARA REYNOLDS:  Thank you, Dr. Frieden.  Shirley, if we could open up the lines for questions, please. 

OPERATOR:  Certainly, this time we'll begin the question and answer session.  If you would like to ask a question, please press star 1 and record your name clearly, again, press star 1 to ask a question.  In one moment please for our first question.  Again, just press star 1 to ask a question and one moment please.  Thank you, our first question is from Eben Brown with Fox News Radio; go ahead with your question. 

EBEN BROWN: Good afternoon, and thank you doctors for doing this.  I've got a couple of questions, one, at the very top, I heard something about reaching out to undiagnosed people or helping to treat undiagnosed people.  Do we have a good estimate on how many people are out there undiagnosed, unknowing they have HIV?  And another question is, is there, I know we have policies for testing and pushes through the affordable care act to have testing paid for through health coverage plans, are there any official guidelines regarding abstinence, that is considered a way to not get HIV. 

TOM FRIEDEN:  Okay.  I'll start and turn it over to Dr. Mermin and McCray.  Currently, about 14 percent of Americans living with HIV have not been diagnosed.  So are unaware of their infection, i believe that's about 170,000 people.  And there are many things being done to increase testing, including making testing a routine part of health care, providing testing support for communities at highest risk in community venues.  And in terms of abstinence, we do emphasize that for particularly for youth in schools, that abstinence is the only certain way to avoid transmission of HIV, and that reducing the number of sexual partners will also reduce the risk of HIV.  Dr. Mermin and McCray?

JONATHAN MERMIN: Um, well thank you.  So the, the proportion of Americans with HIV who know that they have the infection has continuingly increased over the past decade.  And it is one of the signs of success of national efforts for HIV prevention and care.  Over, a little over a decade ago, only 75 percent of people knew they had HIV, and now we're reached 86 percent.  And as Dr. Frieden has highlighted, that allows those individuals to both take care of themselves to access treatment, but also to protect the people that they love from getting infected.  In terms of mechanisms for increasing testing, there's really two main methods we have, one is, is screening people for HIV infection in their routine medical settings per national guidelines.  And we do recommend that in general, people get tested for HIV at least once, and people at increased risk get tested more frequently.  That's, that HIV should be normalized and essentially an HIV test should be as simple to access as a cholesterol check.  The other mechanism for HIV testing is to reach out to people who are at high-risk of infection and who may have been infected since their last negative test and as Dr. Frieden mentioned, to ensure they can access testing easily and link to care if positive. 

BARBARA REYNOLDS:  Thank you, Dr. Mermin.  Next question, please. 

OPERATOR:  Thank you, next question comes from Maggie Fox with NBC News; go ahead with your question. 

MAGGIE FOX:  I know the survey didn't show this, but can you all talk a little bit about why people may not be accessing care.  Is it still difficult?  Do they not trust it?  Is it just a pain in the neck?  What's the explanation? 

TOM FRIEDEN:  I'll turn it over to doctors Mermin and McCray for more detail, but taking treatment for an infection that may have no symptoms, and that you need to take for life is not easy.  That's why it's so important that services for people living with HIV be sensitive, easy to access without financial barriers.  All of those are critically important not just for that individual, but also to reduce the spread of HIV.  Doctors Mermin and McCray?

JONATHAN MERMIN:  Just, I think it's clear that accessing HIV care can be difficult, particularly for people who lack health insurance or don't have experience navigating what can be a complex health care system. In addition, people with HIV infection often have other life circumstances that can make accessing health care more challenging.  HIV infections associated with poverty, with living in an urban setting, sometimes homelessness, there's other factors, substance abuse that can actually increase risk.  So many of those factors can deter people from seeking remaining HIV care… So, there are a variety of activities that CDC is involved with as are other federal agencies and state health and local health departments to try and make it easier for people to access care, so, staying in care can be easier as well.  And that can range from offering case management or patient navigation services to help people coordinate their appointments to help manage medical records and insurance payments and other aspects of the health care system to larger scale programs that, that help everyone in a jurisdiction who knows that they have HIV stay in regular care. 

BARBARA REYNOLDS:  Thank you Dr. Mermin.  Shirley, I think we have time for one more question, please. 

OPERATOR:  Thank you, that comes from Rob Volansky with HTC Next, go ahead with your question. 

ROB VOLANSKY: Hi everybody thanks for doing this today.  Given the new HIV testing protocols, it seems like a lot of, particularly baby boomers, but a lot of other people with Hepatitis C will be flooding the health care system.  And so I was wondering if there's anything in this that's going to deal with people with co-infections with HTC or co-infections with other viral infections in general, thank you. 

TOM FRIEDEN:  Thanks, I’ll turn that over to Dr. Mermin to answer. 

JONATHAN MERMIN: Thank you.  There are many similarities between HIV and Hepatitis C in terms of programmatic response and in terms of both of them being chronic viral infections.  You know, there has been a continuum of care with Hepatitis C infection which shows that only about 50 percent of people with Hepatitis C in the United States know that they're infect and that there is a considerable drop off to the point of people who have been actually treated.  What is different between HIV and Hepatitis C is that Hepatitis C can be cured and HIV is at this point a lifelong infection.  But, but what -- you highlight that the screening recommendations that CDC has issued are similar and it's important that people who are thinking of routinely providing their patients with HIV screening also think of Hepatitis C screening and vice versa.  The linkage to care issues and the retention in care will be similar for people who have Hepatitis C and HIV with the exception that Hepatitis C can be cured, but looking at the final outcome for HIV being viral suppression which maximizing longevity and reducing the risk of infection to others and for hepatitis c is a cure of your infection helps both health departments and the nation achieve the outcomes that are going to have the greatest health impact.  

BARBARA REYNOLDS:  Thank you Dr. Mermin.  Dr. Frieden, if you'd like to conclude. 

TOM FRIEDEN:  Well, first thank you all for joining us.  HIV remains a very significant health threat in the U.S. with more than one million people in this country living with HIV.  We've got such great treatment for HIV now that people living with HIV can have an almost normal lifespan, and taking treatment early is critically important to health.  It's also critically important to protecting sexual contact and protecting your family.  Today's findings are important because they show that we have much, much further to go.  Only three out of ten Americans living with HIV were documented to have their infections effectively controlled, and the great majority of those with infections out of control had been diagnosed, but were not still in care.  That's a message for providers of HIV services to be accountable for every single patient you've diagnosed, and the message for people living with HIV to go in for care because that can save your life and save the life of someone else.  Thank you very much for joining us. 

BARBARA REYNOLDS:  Thank you Dr. Frieden.  This concludes our telebriefing on HIV.  If you have additional questions, would like more information or transcript you're welcome to call 404-639-8894 or 404-639-3286. 

OPERATOR:  Thank you and this does conclude today's conference.  We thank you for your participation.  At this time you may disconnect your line.  

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES