Table 1: Major Milestones in the HIV/AIDS Epidemic 3,4 Year Milestone 2008
JAMA reports that the incidence of HIV infection among gay men in the U.S. is again increasing, following an encouraging period of decline. 2012 HHS issues new HIV treatment guidelines recommending that all adults and adolescents start antiretroviral therapy regardless of CD4+ T cell count or viral load. 2016 CDC reports that only 1 in 5 sexually active high school students has been tested for HIV Cohort study of ART-naïve, HIV patients in Kenya who initiated tenofovir DF indicates that subsequent virologic failure and resulting HIV drug resistance necessitates universal viral load monitoring and prompt drug resistance testing. 2019 HHS launches “Ending the HIV Epidemic: A Plan for American” with the goal of reaching a 75% reduction in new HIV infections by 2025 and at least a 90% reduction by 2030. Evolving role of primary medical care for HIV patients
Success in achieving the goals of the HHS Plan for America will be hampered, in part, by the diminishing number of HIV clinicians in the United States. 6 It is estimated that between 33% and 50% of existing HIV clinicians will stop practicing HIV medicine over the next 10 years. 6 The HIV provider shortage in the US is likely to continue. To address this shortage, it has been suggested that primary care providers (PCPs) be offered additional training and physician assistants (PAs) and family nurse practitioners (NPs) be encouraged to become involved with HIV medicine. 6
Currently, there are approximately 294,834 PCPs in the US, and, of these, 3101 provide care to HIV- positive patients. 6 A 2020 article that sought to answer the question “Are Primary Care Physicians Prepared for Their New Role?” found that 71% of surveyed PCPs believed PCPs should take care of HIV patients. In addition, more than 50% of PAs and NPs believed they could be ready to manage HIV patients with some training. 6 In the past, persons with HIV have been cared for by infectious disease or HIV specialists. However, when patients are treated in primary care, HIV patients are also managed for other chronic medical conditions. Therefore, these patients receive more comprehensive care.
EPIDEMIOLOGY
Scope and impact According to statistics from the HIV.gov website, approximately 1.2 million persons in the US are estimated to be living with HIV and about 13% of these people are not diagnosed and need testing. 7 In 2019, there was an estimated 34,800 new HIV diagnoses. 7
Although there has been an overall decrease in new diagnoses from 2015 to 2019 (Figure 1), HIV diagnoses are not evenly distributed across states/ regions. The highest rates of new infections continue to occur in the southern and southeastern regions of the US. 7
Figure 1: Annual HIV Diagnoses in the US, 2015-2019
Life expectancy in persons with HIV is approaching that of the general population with early diagnosis and prompt initiation of treatment. Despite the fact that deaths attributable to HIV are preventable, in 2017, HIV was still among the top 10 leading causes of death among certain populations. 8
Between 2010 and 2018, both the prevalence of HIV infection and the number of HIV-related deaths were greatest amongblack persons and by US region in the South. 8
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Book Code: CT24CME
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