How Effective is HIV Care in the US Military?
Grant M. Gallagher
A new analysis in the CDC’s MMWR points to success in ART initiation and viral suppression among active duty members of the US armed forces.
In the United States, people living with HIV can still remain in military service after diagnosis. There has not, however, previously been comprehensive analysis of the treatment outcomes among military personnel living with HIV.
The authors of a recent article published in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report examined HIV treatment outcomes for members of the US armed forces from January 2012 through June 2018. The investigators found a high rate of antiretroviral therapy (ART) uptake and viral suppression among military personnel, highlighting that active-duty members have access to a large health care system with robust logistical capabilities.
The authors analyzed data from the Defense Medical Surveillance System to produce estimates of viral suppression and ART use among Department of Defense (DoD) service members with a diagnosed HIV infection.
Out of the 1050 service members with newly diagnosed HIV infections between January 1, 2012 through December 31, 2017, 89.4% initiated ART within 6 months of diagnosis.
Within 12 months of diagnosis, ART uptake increased to 95.4%. By June 30, 2018, 98.7% of the service members included in the study had received ART.
Among 793 service members who initiated ART and remained in the military for a year or longer, 93.8% had continuous ART, and 99% were virally suppressed within a year of ART initiation. At their last viral load test, 96.8% achieved viral suppression.
“The DoD model of HIV care demonstrates that service members with HIV infection who remain in care receive timely ART and can achieve both early and sustained viral suppression,” the authors wrote.
The authors explained that routine HIV screening has significance beyond individual health. Testing is also necessary in a military context in order to protect the battlefield blood supply.
If they can still perform their duties, active duty service members with HIV infection receive care through the Military Health System and are able to remain in the armed forces. Every 6 to 12 months thereafter, clinical evaluations are performed by military infectious disease physicians.
Within the military, treatment of HIV to the point of viral suppression is accessible for the majority of those diagnosed. The benefits of ART make a difference in terms of both individual health and preventing community transmission. However, outside active duty, challenges can arise for veterans.
A study of 42,441 veterans living with HIV and 104,712 veterans who did not have HIV observed between 1999 and 2015 found that HIV-positive veterans who were not virally suppressed had a high incidence of cancer.
A 2019 study in Open Forum Infectious Diseases found that HIV suppression rates were higher among Veterans Affairs patients offered telemedicine.
As the authors of this study note, the success of HIV treatment in the military reflects the broad possibilities offered by a large and well-resourced public health care system.
“The DoD model of HIV care demonstrates that ART and viral suppression goals can be achieved among a segment of the U.S. population who receive clinical care in a large health care system, despite high mobility and geographic dispersal,” the authors concluded.