20M People Worldwide Received HIV Treatment Through U.S.-Led Program

Approximately 20 million people with HIV in 54 countries have received antiretroviral therapy (ART) through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) as of September 2022, the CDC reported.

This represents an increase of 300-fold from the 66,550 reported in September 2004, according to Helen M. Chun, MD, of the Division for Global HIV and TB, Center for Global Health at the CDC, and colleagues.

From 2015 to 2022, viral load coverage increased from 24% to 80%, and viral load suppression increased from 80% to 95%, they noted in the Morbidity and Mortality Weekly Report.

Although the total averted deaths were not included in the report, during a media briefing, Hank Tomlinson, PhD, director of the Division for Global HIV & TB, said that "an estimated 25 million lives [were] saved."

According to Debra Houry, MD, MPH, chief medical officer of the CDC, "this report shows PEPFAR's HIV treatment efforts have dramatically transformed the global HIV epidemic and in less than two decades."

"We must sustain this momentum," she said. "Despite these tremendous achievements, significant gaps remain, fueled by unequal access to lifesaving HIV services."

"There is still much work to be done to close critical gaps and reach certain populations who continue to be left behind due to health inequities," she continued. "CDC's work is centered on addressing these inequities."

Tomlinson further noted that "not directly addressing health equity issues will only hamper progress to eliminate HIV as a global public health threat."

PEPFAR was started by the George W. Bush administration, with an initial goal of saving 7 million lives and treating 2 million people, Chun and team said.

Through PEPFAR, the CDC supports more than 10,000 labs or testing sites worldwide. These labs not only support lifesaving treatments for people with HIV, but also enhance surveillance systems to better understand where services are needed, Chun and colleagues noted.

From 2015 to 2022, the annual number of people with HIV who received a viral load test increased 605%.

"Despite increases in viral load suppression rates and health system strengthening investments, variability exists in viral load coverage among some subpopulations," including children ages 10 and under, men, pregnant women, men who have sex with men (MSM), persons in prisons and other closed settings, and transgender persons, "and in viral load suppression among other subpopulations," including pregnant and breastfeeding women, persons in prisons, and people under 20 years of age, they wrote.

Viral suppression through ART has been integral to reducing transmission, Tomlinson explained. "This can prevent transmission of HIV to sexual partners and helps reduce the risk of transmission from mothers to children."

Notably, during 2017-2022, the viral load suppression rate increased among women, men, children under 10, pregnant women, and breastfeeding women. Men, women, and those ages 20 and older reached viral load suppression rates of ≥95% in 2022, as did female sex workers, MSM, transgender persons, and persons who inject drugs. However, rates among persons in prisons remained unchanged, at 93%.

"Moving forward under PEPFAR's current 5-year strategy, the United States aims to eliminate HIV as a global public health threat by 2030, while strengthening public health systems to respond to other global health crises," Houry said. "We've come a long way in addressing the global HIV epidemic. Eliminating HIV as a global public health threat is within our grasp. We must stay the course so that these decades of progress aren't reversed."

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