Chartbook on Effective Treatment

New AIDS Cases

New AIDS cases per 100,000 population age 13 and over, by race/ethnicity and age, 2000-2011

Left Chart:

2010 Achievable Benchmark: 2.8 per 100,000 Population.

Right Chart:

2010 Achievable Benchmark: 2.8 per 100,000 Population.

Source: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System, 2000-2011.
Note: For this measure, lower rates are better. White, Black, and Asian are non-Hispanic. Hispanic includes all races. Data for Asians in 2000, 2001, and 2002 did not meet criteria for statistical reliability.

• Overall Rate:
  • Improved management of HIV infection has contributed to declines in the number of new AIDS cases in the United States.
  • Overall, in 2011, the total rate of new AIDS cases was 12.4 per 100,000 population.
• Trends:
  • From 2000 to 2011, the rates of new AIDS cases decreased for the total population, Blacks, Hispanics, and Whites.
  • From 2003 to 2011, Asians had lower rates of new AIDS cases than Whites.
  • From 2000 to 2011, the rates of new AIDS cases decreased for those ages 25-34, 35-44, and 45-54.
  • The rate of new AIDS cases worsened for those ages 13-24.
• Disparities:
  • In all years, Blacks and Hispanics had higher rates of new AIDS cases compared with Whites, but the gap between Blacks and Whites is narrowing.
  • From 2000 to 2011, people ages 25-34, 35-44, and 45-54 had higher rates of new AIDS cases compared with those age 55 and over. The gap between those ages 35-44 and 55 and over is narrowing over time.
• Achievable Benchmark:
  • The 2010 top 5 State achievable benchmark for new AIDS cases was 2.8 per 100,000 population. The top 5 States that contributed to the achievable benchmark are Iowa, Maine, South Dakota, Utah, and Wisconsin.
  • At the current rate, the total population could not achieve the benchmark for 17 years. Whites would take 9 years, Hispanics 11 years, and Blacks 18 years. Asians are not making progress toward the benchmark.
  • People ages 25-34 and 35-44 could not achieve the benchmark for 18 years and 11 years, respectively. Those ages 13-24 are moving away from the benchmark, and those ages 45-54 and 55 and over are not making progress toward the benchmark.

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Outpatient Visits Among HIV Patients

HIV patients who had two or more outpatient visits, by race/ethnicity and sex, 2011

Source: Agency for Healthcare Research and Quality, HIV Research Network, 2011.
Note: White and Black are non-Hispanic. Hispanic includes all races.

• Overall Rate:
  • In 2011, 88.9% of people with HIV were retained in care, defined as having two or more outpatient visits during the year.
  • The percentage of HIV patients retained in care in 2011 follows:
    • Whites, 88.1%.
    • Blacks, 88.6%.
    • Hispanics, 90.6%.
    • Males, 89%,
    • Females, 88.7%.
• Groups With Disparities:
  • In 2011, there were no statistically significant differences by race/ethnicity or sex in the percentage of people with HIV retained in care.

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HIV Patients With Viral Load Below 200

Adult HIV patients with viral load <200 for first test in the year, by race/ethnicity, sex, age, and insurance, 2011

Source: Agency for Healthcare Research and Quality, HIV Research Network, 2011.
Note: Viral load suppression means HIV RNA <200 copies/mL. White and Black are non-Hispanic. Hispanic includes all races.

• Overall Rate:
  • Viral load suppression below 200 copies/mL is desired, as this improves morbidity and mortality for people living with HIV and decreases the chances of spreading HIV. Thus, it is essential for HIV patients to continue to adequately manage the disease, by adhering to antiretroviral therapy and getting regular viral load testing.
  • In 2011, 73.1% of adult HIV patients had a suppressed viral load, defined as HIV RNA less than 200 mL for the first test in the year.
• Groups With Disparities:
  • In 2011, the percentage of adult HIV patients with viral load suppression was lower for Blacks (67.4%) compared with Whites (80.6%) and lower for females (68.5%) compared with males (74.9%).
  • In 2011, the percentage of adult HIV patients with viral load suppression was lower for adults ages 18-44 (66.3%) compared with those ages 45 and over (77.8%).
  • In 2011, the percentage of adult HIV patients with viral load suppression was lower for those with Medicaid (67.1%) and Medicare/dual eligible (78.8%) compared with people with private insurance (82.3%).

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Deaths of People With HIV Infection

• A number of factors affect the death rate among people living with HIV, including:
  • Underlying rates of HIV risk behaviors.
  • Prevention of HIV transmission.
  • Early detection and treatment of HIV disease.
  • Management of AIDS and its complications and comorbidities.
• With widespread use of antiretroviral therapy, a better understanding is needed of the patterns and risk factors for cause-specific mortality.

Hepatitis and Deaths of People With HIV Infection

• An estimated one-third of people with HIV are co-infected with hepatitis B or hepatitis C; hepatitis C is more common.
• Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those without HIV.
• Drug therapy has extended the life expectancy of people with HIV, but hepatitis has become the leading cause of non-AIDS-related death in this population (CDC, 2014).
• Hepatitis C increases the risk of death in HIV patients by about 50% (Branch, et al., 2012).
• Current recommendations are to screen all HIV-infected patients for hepatitis C.
  • Patients at high risk for hepatitis C should be screened annually and whenever this infection is suspected (AIDS Info, 2014).

Antiretroviral Therapy and HIV Deaths

• ART has reduced the death rate of people living with HIV (PLWH), allowing their life expectancy to approach that of the general population.
• AIDS-related deaths in PLWH decrease with time on ART, but overall mortality among PLWH remains higher than in the general population.
• As the HIV-infected population ages and time on ART increases, causes of death and association with patient characteristics are changing:
  • In high-income countries, deaths from cancer, cardiovascular disease, and liver disease have been identified among PLWH.
  • It is important to study cause-specific mortality to clarify whether these deaths result from effects of ART, prolonged exposure to HIV, restoration of CD4 counts after severe immunosuppression, or aging and non-HIV risk factors.
• Appropriate management based on the complex relationship between associated comorbidities and HIV disease could decrease mortality among PLWH and improve their quality of life (Ingle, et al., 2014).

Deaths Due to HIV Infection

Number of deaths due to HIV infection per 100,000 population, by race and sex, 2000-2011

Left Chart:

2008 Achievable Benchmark: 0.9 per 100,000 Population.

Right Chart:

2008 Achievable Benchmark: 0.9 per 100,000 Population.

Key: API = Asian or Pacific Islander, AI/AN = American Indian or Alaska Native.
Source:  Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2000-2011.
Note: For this measure, lower rates are better. Rates are age adjusted to the 2000 U.S. standard population.

• Overall Rate: In 2011, the total rate of HIV infection deaths was 2.4 per 100,000 population. HIV infection death rates are decreasing overall and for all racial/ethnic groups and both sexes.
• Groups With Disparities:
  • From 2000 to 2011, HIV infection death rates were higher for Blacks than for Whites. The disparity between Blacks and Whites is narrowing.
  • In all years, Asians and Pacific Islanders had lower rates than Whites.
  • In all years, the rate of HIV infection deaths was higher for males than for females.
• Achievable Benchmark:
  • The 2008 top 4 State achievable benchmark for HIV deaths was 0.9 per 100,000 population. The top 5 States that contributed to the achievable benchmark are Kansas, Minnesota, Oregon, and Wisconsin.
  • Overall, it would take the total population 6 years to reach the benchmark. At the current rate, Whites, Blacks, and AI/ANs could achieve the benchmark in 3, 8, and 2 years, respectively. APIs have already reached the benchmark. Women would take 3 years and men would take 6 years to achieve the benchmark.

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