Approximately a third of young people newly linked to HIV care in the United States have viral loads that indicate a high risk of onward transmission, according to research published in the online edition of AIDS. Young men who have sex with men (MSM) had a mean viral load of approximately 125,000 copies/ml, significantly higher than the average of 47,000 copies/ml recorded in their heterosexual peers.
Moreover, a potentially highly infectious viral load of 50,000 copies/ml or above was recorded in 30% of young MSM compared to 22% of young heterosexual people. “These viral load levels are associated with high rates of transmission,” comment the authors. “YMSM [young MSM] are well represented in these data…and they have the highest viral loads, which is consistent with the high rates of ongoing transmission in this population in the United States.”
However, the results may not be entirely bad news. The investigators acknowledge the high viral loads they recorded could be because young people are being diagnosed promptly.
The study involved people aged between 12 and 24 years who were newly linked to HIV care in 2010-11.
Late diagnosis is an important factor underlying much of the HIV-related illness and death that still occurs in the United States. The National HIV/AIDS Strategy therefore emphasises the importance of improving both diagnosis rates and the proportion of people linked and retained in care. Linkage to care also has public health benefits, enabling people to access antiretroviral therapy and thereby reducing their risk of passing HIV on to sexual partners. A ‘test and treat’ strategy is viewed by some as being a way of controlling the epidemic. Approximately a quarter of new HIV infections in the United States involve people aged between 13 and 24 years, and 87% of all infections in young people involve young MSM. The SMILE in Caring for Youth project is a multi-agency collaboration to improve rates of HIV diagnosis and linkage to care among people aged between 12 and 24. Investigators from the project wished to describe the CD4 cell counts and viral load characteristics of young people newly engaging with HIV care.