A wave of recent studies brings troubling news that U.S. HIV infection rates may have been underestimated by as much at 40%, particularly among African-Americans and men who have sex with men (MSM). As many as 58,500 people each year are becoming newly infected with HIV in America, rather than the 40,000 estimated in prior Centers for Disease Control and Prevention (CDC) reports.

The new CDC study, published in the August issue of The Journal of the American Medical Association, indicates that HIV incidence (the number of new HIV infections occurring in a given time period) has been higher than previously thought for at least a decade.

Dr. Stephen J. Brown, Medical Director at ARA said “This study lifts the veil on just how serious a threat AIDS continues to pose in the United States.”

These startling numbers highlight the need for expanded access to HIV testing, more rigorous tracking and reporting standards nationwide, and an even greater sense of urgency to develop and test new drug candidates, vaccine candidates, and prevention methods.

The revised numbers are due to better reporting, rather than increased risk behavior. The study relies on reporting advances on two fronts:

      • A breakthrough testing technology that allows researchers to see which HIV infections are new, i.e., those that occurred within approximately the last five months.
      • An expanded HIV reporting system in the U.S., and new statistical methods that examined historical trends in HIV infections.

By combining these methods, CDC was able to track new infections for the first time.

In a statement, the CDC says, “this combined approach will allow CDC to better monitor the current course of the epidemic, target prevention efforts where they are needed most, and assess the impact of prevention efforts.” In the next year, CDC expects further information to come out of the study, including more reliable figures on the total number of people infected nationwide. The statement goes on to caution that the numbers do not represent a rise in the number of cases, and that the new analysis shows that infection rates have been relatively steady over the last decade.

“This is yet another – louder – wake up call that the US must do better in the prevention, diagnosis, and treatment of this disease. As a nation, we must fund the research that will help us turn these infection rates around,” stated Carolyn H. Carlburg, J.D., CEO.

A Morning Before Pill? Looking At New Tools For Prevention

With the HIV vaccine research community still reeling from last year's Merck vaccine trial closure - and more new infections being reported across the U.S. - other new approaches are generating tremendous public interest. This includes pre-exposure prophylaxis (PrEP), in which antiretroviral drugs are used before potential HIV exposure to reduce the likelihood of infection.

The approach isn't new: anti-malarial drug regimens rely on the same basic premise of loading the body with drugs to fight off infection before a patient encounters the infectious agent. Theoretically, if HIV replication can be stopped from the moment the virus enters the body, it may not be able to establish a permanent infection.

"We know that behavioral interventions (Such as abstinence, condom use, and needle hygiene) can be effective in preventing HIV infection; however, they aren't always used, are not universally available, and have not been able to contain the pandemic," stated Dr. Marjan Hezareh, ARA Scientific Director

In fact, with 7,400 new infections occurring every day, new (and combined) prevention approaches are desperately needed, and HIV researchers must turn their focus to studying the use of currently available antiretrovirals as a preventive method.

This was just the recommendation made last month at the 17th Annual International AIDS Conference by the AIDS Vaccine Advocacy Coalition. With PrEP clinical trials currently planned or underway in Africa, Asia, Latin America and North America, the Coalition called for increased action from governments, global health institutions and researchers to prepare as early data from those trials comes in - expected as early as 2009 - from these first trials.

Although it is still unproven in human trials, already there is some evidence that PrEP works: providing antiretrovirals to HIV-infected women during labor and delivery and to their newborns immediately following birth has been shown to reduce the risk of mother-to-child transmission by about 50. A safe and effective PrEP therapy would likely be targeted to men who have sex with men (MSM), female partners of MSM, and intravenous drug users and their partners. Other individuals who might be considered for PrEP would be those placed in situations or locations where risk of HIV acquisition might be heightened for a period of time, such as prisoners, commercial sex workers, or those trying to conceive with an HIV+ partner.

Once study results are available, and the risks and benefits carefully considered, the important task of implementing this possible new therapy can begin.

If you’re a government employee (or know one), you probably know about the Combined Federal Campaign. Every year forest rangers, marines, librarians, school teachers, NASA techs, postal workers and many others contribute from their payroll as part of the world's largest and most successful workplace charity campaign. From September thru December 15th, federal, state and municipal employees across the nation, as well as overseas, are asked to donate a portion of their wages to U.S. charities.

Charities chosen for the CFC must meet strict guidelines to participate, including show evidence that they are providing services on a national or international level; that they abide by public and financial accountability guidelines; and that they provide complete transparency with regard to how much money they spend on overhead (for instance, AIDS Research Alliance spends nearly .85 cents of every dollar received on research and education.)

Whether you work for a federal, state or municipal agency or donate through the United Way, please consider donating to ARA through your workplace giving campaign. (In the CFC, we can be found at 12134.)

To find out how you can donate through your workplace – or to see whether your employer supports and matches your donations to ARA – please contact our Development Assistant, Gwendolyn Martin at 310-358-2423, or at gmartin@aidsresearch.org.