HIV: from 80s to Today

HIV: From the 80s to Today

HIV is a virus that attacks the immune system and can cause AIDS, a condition that can lead to serious illnesses and death. HIV is transmitted through certain body fluids, such as blood, semen, vaginal fluid, or breast milk. HIV can be prevented by using condoms, taking pre-exposure prophylaxis (PrEP), or being on antiretroviral therapy (ART) if infected. In this article, we will explore the history and trends of HIV in the USA, from the 80s to today, and discuss the statistics and projections of HIV prevalence and life expectancy.

History and Trends of HIV

The first cases of AIDS in the USA were reported in 1981 among gay men in Los Angeles, New York, and San Francisco. By 1982, AIDS was also found among injection drug users, hemophiliacs, and heterosexuals. The cause of AIDS was identified as a new virus, later named HIV, in 1983. The first blood test for HIV was developed in 1985. The first drug to treat HIV, zidovudine (AZT), was approved in 1987.

The 80s and early 90s were marked by a rapid increase in HIV infections and AIDS deaths in the USA. The epidemic disproportionately affected gay and bisexual men, especially those of color, as well as injection drug users and their sexual partners. The stigma and discrimination faced by people living with HIV/AIDS (PLWHA) fueled the social and political activism of groups such as ACT UP and Gay Men’s Health Crisis. The public awareness of HIV/AIDS was also raised by celebrities such as Rock Hudson, Freddie Mercury, Magic Johnson, and Ryan White.

The mid-90s saw a turning point in the HIV epidemic in the USA with the introduction of highly active antiretroviral therapy (HAART), a combination of drugs that can suppress HIV replication and improve immune function. HAART reduced the morbidity and mortality of PLWHA and transformed HIV from a fatal disease to a chronic condition. HAART also reduced the risk of transmitting HIV to others by lowering the viral load in body fluids.

The late 90s and early 2000s witnessed a stabilization of HIV infections and AIDS deaths in the USA. The epidemic continued to affect mostly gay and bisexual men of all races and ethnicities, as well as African Americans and Hispanics/Latinos of both sexes. The prevention efforts focused on increasing HIV testing, promoting condom use, providing needle exchange programs, and expanding access to HAART.

The late 2000s and early 2010s saw a slight decline in HIV infections but not AIDS deaths in the USA. The epidemic remained concentrated among key populations such as gay and bisexual men, especially young ones; African Americans; Hispanics/Latinos; transgender women; and people living in the South. The prevention strategies included new biomedical interventions such as pre-exposure prophylaxis (PrEP), a daily pill that can prevent HIV infection; post-exposure prophylaxis (PEP), a short course of drugs that can prevent HIV infection after exposure; and treatment as prevention (TasP), which means that PLWHA who are on HAART and have an undetectable viral load cannot transmit HIV to others.

The late 2010s and early 2020s saw a further decline in HIV infections but not AIDS deaths in the USA. The epidemic still affected mostly the same key populations as before. The prevention efforts aimed at ending the HIV epidemic by 2030 through four pillars: diagnose all people with HIV as early as possible; treat PLWHA rapidly and effectively; prevent new HIV infections using proven methods such as PrEP; and respond quickly to potential outbreaks using data and technology.

According to the latest estimates from the Centers for Disease Control and Prevention (CDC), approximately 1.2 million people in the USA have HIV. About 13 percent of them don’t know it and need testing. HIV continues to have a disproportionate impact on certain populations, particularly racial and ethnic minorities and gay, bisexual, and other men who have sex with men. In 2019, an estimated 34,800 new HIV infections occurred in the USA. New HIV infections declined 8% from 37,800 in 2015 to 34,800 in 2019, after a period of general stability. In 2020, 30,635 people received an HIV diagnosis in the USA and 6 dependent areas—a 17% decrease from the prior year, likely due to the impact of the COVID-19 pandemic on HIV prevention, testing, and care-related services.

Statistics and Projections of HIV Prevalence and Life Expectancy

HIV prevalence refers to the number of people living with HIV at a given point in time. HIV prevalence can be expressed as a number or a percentage of the population. HIV prevalence can help measure the burden of the epidemic and the need for treatment and care.

According to the CDC, the HIV prevalence in the USA was estimated at 1,189,700 people at the end of 2019, the most recent year for which this information is available. Of those people, about 87% knew they had HIV. The HIV prevalence rate was 0.4% of the total population.

According to a study by Althoff et al., published in 2019 in AIDS journal, the HIV prevalence in the USA is projected to increase to 1,232,000 people by 2025 and 1,263,000 people by 2030. The study also projected that the proportion of PLWHA who are aged 65 or older will increase from 19% in 2016 to 28% in 2025 and 35% in 2030.

HIV life expectancy refers to the average number of years that a person with HIV can expect to live after diagnosis. HIV life expectancy can be influenced by many factors such as the age at diagnosis, the stage of infection, the access to treatment and care, the adherence to medication, the presence of co-infections or co-morbidities, and the social and economic determinants of health.

According to a study by Schackman et al., published in 2016 in Medical Care journal, the average life expectancy for PLWHA in the USA was estimated at 71 years (in 2010 dollars). This life expectancy included antiretroviral therapy (253,967), opportunistic infection prophylaxis (8,088), opportunistic infection treatment (45,542), other health care costs (54,524), and other non-health care costs ($17,546). The study also estimated that early diagnosis and treatment could increase life expectancy by 10 years and reduce lifetime cost by 9%.

According to a study by Marcus et al., published in 2020 in Annals of Internal Medicine journal, the average life expectancy for PLWHA in the USA was estimated at 77 years (in 2017 dollars). This life expectancy was comparable to that of the general population (78 years). The study also estimated that early diagnosis and treatment could increase life expectancy by 13 years and reduce lifetime cost by 13%.

These studies show that HIV life expectancy in the USA has improved significantly over time due to advances in treatment and care. However, there are still disparities in life expectancy among different groups of PLWHA based on factors such as race/ethnicity, sex, age, transmission category, or geographic region. Therefore, there is still a need for more efforts to reduce the gaps and barriers in accessing and adhering to quality HIV services for all PLWHA.