The Journal of the Arkansas Medical Society Med Journal Sept 2019 FInal 2 | Page 4

COMMENTARY
ENDING THE HIV EPIDEMIC
Naveen Patil, MD, MHSA, MA, FACP, FIDSA; Charles Bedell, MD, MPH; Nick Butler, BS
254
That’s the number
of persons reported
as newly-infected
with Human Immunodeficiency Virus
(HIV) in Arkansas in 2017. In that same • Treat new infections rapidly and effectively in order
to achieve sustained viral suppression.
year, an additional 152 persons were reported as new
cases of Acquired Immuno-Deficiency Syndrome (AIDS).
Across the U.S., for the same year, there were 1.1 million
people with a diagnosis of HIV, of which 38,739 were
new infections. Also important, 15% currently infected
(one out of every seven persons) are not even aware of
their infection. To bring all this together, state HIV workforces,
coordinating with federal partners at Health Resources
Services Administration (HRSA) and CDC, must set
up elimination teams dedicated to the success of
these initiatives within each jurisdiction. The Arkansas
Department of Health has an Infectious Disease
Branch that has administrative responsibilities for HIV
prevention and HIV care and treatment. Both program
areas collaborate with federal agencies via specific
funding arrangements to implement activities for
HIV prevention, care, and treatment with the goal of
diagnosing all HIV infections within the jurisdiction
and linking persons diagnosed to care and treatment
services for the attainment of HIV virologic suppression
or control. In Arkansas, as of December 31, 2017, 6087
persons were diagnosed and living with HIV disease
(HIV: 3,452; AIDS: 2635).
Despite advances in HIV treatment and care, there
has not been a decline in the number of new infections,
which remains at about 39,000 per year over the past five
years. The apparent levelling off of reported new cases
was explained as being due to (i) effective HIV prevention
measures and (ii) effective available HIV treatment not
adequately reaching those who could most benefit from
it. It must be noted that the reported new infections of
HIV are neither equally distributed across the U.S. nor
across the 75 counties in Arkansas. Nationwide, HIV
surveillance depicts a striking geographic distribution
pattern for new cases of HIV. Data from 2016-2017
show that 50% of new HIV diagnoses occurred in only
48 counties, Washington D.C., and San Juan, Puerto
Rico. These “hot spots” further define intervention gaps,
particularly in rural areas in the U.S. South, where seven
states are shown to bear a substantial rural burden of
new HIV transmissions (Alabama, Arkansas, Kentucky,
Oklahoma, Mississippi, Missouri, and South Carolina). In
these states, this shows up among affected populations
that include African Americans and Latinos, especially in
men who have sex with men.
During his 2019 State of the Union address
before the Congress on Feb. 5, 2019, President Trump
challenged the country to work towards the elimination
of the HIV epidemic in the U.S. by 2030. To this end, the
President made it a cardinal pillar of his administration
to undertake significant, simultaneous, and sustained
activities backed by established HIV scientific research
and development and allocation of additional federal
funding through the Centers for Disease Control and
Prevention and Health and Human Services to “end
the epidemic.” The President’s goal, simply stated, is
to ensure a 75% reduction in new HIV infections in
five years, and at least a 90% reduction in new HIV
infections in 10 years.
Four primary areas of emphasis have been
defined to achieve this goal:
• Diagnose all people with HIV as early as possible
after infection.
• Protect people at risk for HIV using proven and
potent interventions, including PrEP.
• Respond rapidly to detect growing HIV clusters and
prevent new infections.
One significant driver of the HIV epidemic,
particularly new infections, is individuals infected but not
diagnosed. Per the CDC, it is estimated that 1,122,900
adults and adolescents in the 50 states and the District
of Columbia were living with HIV at the end of 2015.
Of those, 162,500 (15%) had not received a diagnosis,
but had contributed to the majority of new infections.
Living infected and undiagnosed forms the basis of one
of the major focuses of ongoing HIV prevention efforts
by both the CDC and HRSA. At the moment, ADH efforts
are to integrate with and support ongoing HIV prevention
initiatives to target this cohort.
Another aspect of the initiative is to equip high-risk
individuals who may develop HIV with Pre Exposure
Prophylaxis (PrEP). ADH is exploring options to identify
these high-risk individuals who may benefit from PrEP
and at the same time are encouraging community
providers to offer PrEP to high-risk groups. ADH has
the expertise to train community providers who may
be interested in offering PrEP services in their practices.
ADH currently has an Integrated HIV Prevention
& Care Plan for the state of Arkansas as well as an
Ending the Epidemic plan under development. All these
prevention, care, and treatment efforts in Arkansas are
being enhanced with the President’s expressed drive to
end this epidemic by 2030. The ADH Infectious Disease
Branch is working closely with several community
partners and health care providers in our state to
implement these HIV prevention, care, and treatment
programs.
52 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
David Wroten
Executive Vice President
Penny Henderson
Executive Assistant
Journal Advertising
Nicole Richards
Managing Editor
Jeremy Henderson
Art Director
EDITORIAL BOARD
Appathurai Balamurugan, MD, DrPH, MPH
Family & Preventative Medicine/Public Health
Tim Paden, MD
Family Medicine
Sandra Johnson, MD
Dermatology
Issam Makhoul, MD
Oncology
Naveen Patil, MD, MHSA, MA, FIDSA
Internal Medicine/Infectious Disease
Benjamin Tharian, MD, MRCP, FACP, FRACP
Gastroenterologist/Hepatologist
Robert Zimmerman, MD
Urology
Tobias Vancil, MD
Internal Medicine
Darrell Over, MD
Family Medicine
EDITOR EMERITUS
Alfred Kahn Jr., MD (1916-2013)
ARKANSAS MEDICAL SOCIETY
2019-2020 OFFICERS
Dennis Yelvington, MD, Stuttgart
President
Lee Archer, MD, Little Rock
Immediate Past President
Chad Rodgers, MD, Little Rock
President Elect
Seth Barnes, MD, Hot Springs
Vice President
George Conner, MD, Forrest City
Secretary
Bradley Bibb, MD, Jonesboro
Treasurer
Danny Wilkerson, MD, Little Rock
Chairman of the Board of Trustees
VOLUME 116