Ending the HIV Epidemic in the United States: Closing the Implementation Gaps
Authors: Hilary D. Marston, Carl W. Dieffenbach, Anthony S. Fauci
Journal: Annals of Internal Medicine (2018)

Editorials18 September 2018Ending the HIV Epidemic in the United States: Closing the Implementation GapsHilary D. Marston, MD, MPH, Carl W. Dieffenbach, PhD, and Anthony S. Fauci, MDHilary D. Marston, MD, MPHOffice of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (H.D.M., A.S.F.), Carl W. Dieffenbach, PhDDivision of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland (C.W.D.), and Anthony S. Fauci, MDOffice of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (H.D.M., A.S.F.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1944 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2014, the Joint United Nations Programme on HIV/AIDS and partners created the "90-90-90" targets, a high-level road map to end the HIV/AIDS pandemic. Specifically, they challenged all countries to diagnose 90% of HIV infections within their borders, provide effective antiretroviral therapy (ART) to 90% of diagnosed persons, and achieve viral suppression (an undetectable viral load) in 90% of treated patients (1). The goal, therefore, was for at least 73% of people living with HIV to achieve viral suppression. The strategy was based largely on the groundbreaking finding of the international clinical trial HPTN 052, which found that sustained viral ...References1. Joint United Nations Programme on HIV/AIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2014. Accessed at www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf on 8 July 2018. Google Scholar2. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al; HPTN 052 Study Team. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830-9. [PMID: 27424812] doi:10.1056/NEJMoa1600693 CrossrefMedlineGoogle Scholar3. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al; PARTNER Study Group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316:171-81. [PMID: 27404185] doi:10.1001/jama.2016.5148 CrossrefMedlineGoogle Scholar4. Bavinton BR, Pinto AN, Phanuphak N, Grinsztejn B, Prestage GP, Zablotska-Manos IB, et al; Opposites Attract Study Group. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018. [PMID: 30025681] doi:10.1016/S2352-3018(18)30132-2 CrossrefMedlineGoogle Scholar5. Centers for Disease Control and Prevention. Understanding the HIV Care Continuum. Atlanta: Centers for Disease Control and Prevention; 2018. Accessed at www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf on 9 July 2018. Google Scholar6. Nance RM, Delaney JAC, Simoni JM, Wilson IB, Mayer KH, Whitney BM, et al. HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015. A cohort study. Ann Intern Med. 2018;169:376-84. doi:10.7326/M17-2242 LinkGoogle Scholar7. Singh S, Mitsch A, Wu B. HIV care outcomes among men who have sex with men with diagnosed HIV infection - United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:969-74. [PMID: 28934185] doi:10.15585/mmwr.mm6637a2 CrossrefMedlineGoogle Scholar8. Mendoza MCB, Gardner L, Armon C, Rose C, Palella FJ, Novak R, et al; HIV Outpatient Study Investigators. Time spent with HIV viral load >1500 copies/mL among patients in HIV care, 2000–2014. AIDS. 2018. [PMID: 29958190] doi:10.1097/QAD.0000000000001921 CrossrefMedlineGoogle Scholar9. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. 2018. Accessed at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf on 9 July 2018. Google Scholar10. Pilcher CD, Ospina-Norvell C, Dasgupta A, Jones D, Hartogensis W, Torres S, et al. The effect of same-day observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US public health setting. J Acquir Immune Defic Syndr. 2017;74:44-51. [PMID: 27434707] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (H.D.M., A.S.F.)Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland (C.W.D.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1944.Corresponding Author: Anthony S. Fauci, MD, Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 31, Suite 7A03, Bethesda, MD 20892; e-mail, [email protected]nih.gov.Current Author Addresses: Drs. Marston and Fauci: Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 31, Suite 7A03, Bethesda, MD 20892.Dr. Dieffenbach: Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD 20852-9831.This article was published at Annals.org on 21 August 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015 Robin M. Nance , J.A. Chris Delaney , Jane M. Simoni , Ira B. Wilson , Kenneth H. Mayer , Bridget M. Whitney , Frances M. Aunon , Steven A. Safren , Michael J. Mugavero , W. Christopher Mathews , Katerina A. Christopoulos , Joseph J. Eron , Sonia Napravnik , Richard D. Moore , Benigno Rodriguez , Bryan Lau , Rob J. Fredericksen , Michael S. Saag , Mari M. Kitahata , and Heidi M. Crane Metrics Cited byData Velocity in HIV-Related Implementation Research: Estimating Time From Funding to PublicationTest, treat, and maintain: rapid initiation of antiretroviral therapyHighly variable trends in rates of newly diagnosed HIV cases in U.S. hotspots, 2008-2017Importance of rigorous implementation science studies to scale-up evidence-based interventions to end the HIV epidemic in the United StatesRecent Substance Use and Probability of Unsuppressed HIV Viral Load Among Persons on Antiretroviral Therapy in Continuity CareSuboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-AnalysisHIV Viral Suppression TrendsPamela Klein, PhD, Paul Mandsager, MSPH, Antigone Dempsey, MEd, Heather Hauck, MSW, LICSW, and Laura Cheever, MD, ScMEngaging men in HIV treatment and prevention 18 September 2018Volume 169, Issue 6Page: 411-412KeywordsAge groupsAllergy and immunologyAntiretroviral therapyCohort studiesHIVHIV infectionsHeterosexualsInfectious diseasesMale male sexual contactViral load ePublished: 21 August 2018 Issue Published: 18 September 2018 PDF downloadLoading ...