The U.S. HIV epidemic at CROI 2016: Black gay men have a 1 in 2 lifetime risk
BETA is reporting from the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) this week in Boston—bringing you the latest news, updates, and research on HIV treatment and prevention.
At a time when effective antiretroviral treatment is widely used and effective pre-exposure prophylaxis is coming on line nationwide, a pair of studies presented this week at the Conference on Retroviruses and Opportunistic Infections (CROI) examined the lifetime risk of being diagnosed with HIV and how long people can expect to live with the virus.
Lifetime HIV risk
Kristen Hess from the Centers for Disease Control and Prevention (CDC) and her team used national data on the number of HIV diagnoses and deaths between 2009 and 2013 to estimate the probability of ever being diagnosed with HIV. The new estimates were compared to findings from an analysis done in 2004-2005.
The overall lifetime risk of ever being diagnosed as HIV-positive was lower than it was a decade ago, falling from 1 in 78 during 2004-2005 to 1 in 99 during 2009-2013. But the risk varies widely among population subgroups and “major disparities persist” Hess said at a CROI press conference.
The lifetime risk of HIV diagnosis was higher for men (1 in 64) than for women (1 in 227). African Americans had the highest lifetime risk of any racial/ethnic group: 1 in 20 for black men and 1 in 48 for black women. Diagnosis rates for Latinos were lower (1 in 48 for men and 1 in 227 for women), but still considerably higher than the risk for white people (1 in 132 for men and 1 in 880 for women) or Asian Americans (1 in 174 for men and 1 in 883 for women).
The analysis confirmed that gay and bisexual men are most heavily affected by the HIV epidemic, with a 1 in 6 chance of ever being diagnosed. This risk is nearly 80 times higher than for heterosexual men.
Breaking the categories down further, black gay and bi men had the highest risk of any subgroup, with 1 in 2 expected to be diagnosed over a lifetime. The risk was 1 in 4 for Latino gay men, 1 in 11 for white gay men, and 1 in 14 for Asian gay men.
People who inject drugs also had a much higher lifetime risk than the population as a whole: 1 in 36 for men and 1 in 23 for women. For black people who inject drugs, the risk was 1 in 9 for men and 1 in 6 for women. Unlike the population overall, in this sub-group women were more likely to be diagnosed with HIV than men.
In contrast, white heterosexuals who did not inject drugs had the lowest likelihood of ever being diagnosed, 1 in 2514 for men and 1 in 1083 for women. The researchers did not report separate figures for lesbians or for transgender men or women.
Looking at geography, the lifetime risk of diagnosis risk ranged from a low of 1 in 670 in North Dakota to a high of 1 in 49 in Maryland. People living in the southeast were more likely to be diagnosed while those in the northwest were least likely. The highest risk of all was seen in Washington, D.C., at 1 in 13.
“As alarming as these lifetime risk estimates are, they are not a foregone conclusion,” said Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention. “They are a call to action…hundreds of thousands of people will be diagnosed in their lifetime if we don’t scale up efforts now.”
Julia Marcus, PhD, from Kaiser Permanente Northern California and colleagues compared life expectancy among approximately 25,000 HIV-positive and 250,000 HIV-negative health plan members between 1996—the advent of effective antiretroviral therapy—and 2011.
They found that a 20-year-old person with HIV could expect to live to age 69, compared to age 82 for HIV-negative people. But an HIV-positive person who started antiretroviral treatment early, did not have hepatitis B or C, did not use drugs or drink heavily, and did not smoke could expect to live to age 79.
Although significant survival gains were seen for all gender, race/ethnicity, and risk factor subgroups, HIV-positive African Americans still had the shortest life expectancy during the later years of the study, at 66 years, compared with 70 years for whites and 72 years for Latinos.
Not surprisingly, life expectancy increased over time as HIV treatment improved and became more widely available. In 1996, 20-year-olds with HIV could only expect to live 19 more years, but in 2011 they could look forward to 53 more years.
Hess K et al. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. CROI 2016. Abstract 52.
CDC. Lifetime Risk of HIV Diagnosis in the United States. Fact sheet. February 2016.
Marcus JL et al. Narrowing the Gap in Life Expectancy for HIV+ Compared With HIV- Individuals. CROI 2016. Abstract 54.