HIV diagnoses among Iowans over 45 reach all-time high in 2013

Officials stress need for routine testing

Undergraduate researcher Elizabeth Mueller works in a microbiology lab at the University of Iowa's Bowen Science building on Thursday, October, 3, 2013 in Iowa City, Iowa. (Adam Wesley/Gazette-KCRG TV9)
Undergraduate researcher Elizabeth Mueller works in a microbiology lab at the University of Iowa's Bowen Science building on Thursday, October, 3, 2013 in Iowa City, Iowa. (Adam Wesley/Gazette-KCRG TV9)

WASHINGTON — Prevalence of the HIV/AIDS virus in Iowa has stayed relatively stable for the past several years, with neither dramatic increases or decreases in the number of cases.

But one of Iowa’s top HIV/AIDS supervisors said that means the disease isn’t going away any time soon, despite decades of improvement in medical technology and research that are allowing patients to live longer.

The Iowa Department of Public Health logged 122 cases of infection in 2013 of human immunodeficiency virus, which often leads to full-blown AIDS, or acquired immunodeficiency syndrome. Statewide, diagnoses of HIV increased by five cases over 2012, and six more than the five-year average of 116, but are still well below the state peak of 126 cases that was reached in 2009.

Continuing a trend, most diagnoses were of men, although there has been a slight uptick from 21 cases among women in 2012 to 34 in 2013.

Jerry Harms, HIV/AIDS surveillance coordinator at IDPH, said the various increases are not statistically significant without studying them over a longer period of time.

“The increases are reasonable when you look at it over time,” Harms said. “It goes up and it goes down. But it’s still here.”

Other factors concern Harms more.

Diagnoses among Iowans above 45 years of age reached an all-time high of 50 cases last year, and officials also are concerned that nearly 40 percent of the new cases are “late testers,” or people who have generally been infected for many years and did not undergo routine testing.

That means the HIV is more likely to have developed into AIDS. Most people in this category also are generally older, or above 45 years of age.

“It may be that those people either don’t have health insurance, or don’t make it a habit to see a physician until they really don’t feel well, and then they come in and are diagnosed with HIV or AIDS,” he said. “That’s one of the things that seems to mark our situation here in Iowa, and that’s why we really can’t emphasize routine testing and knowing your partner.”

Harms defined routine testing as once per year.

Dramatic increases in medical technology and the quality of anti-virus medications have helped, however. At the end of 2013, there were 2,100 Iowans living with either HIV or AIDS. Only a year before, there were 2,023 patients living with either one of the viruses.

“There’s no doubt” that people are living longer, Harms said. “We do a lot of things to track life expectancy, and it’s stayed pretty stable. So if your number of deaths stays stable and you continue to get new diagnoses, then your prevalence is going to go up a little bit. People’s immune systems do tend to improve with proper treatment.”

Iowa Sen. Tom Harkin, a Democrat who chairs the Senate Health Committee, said his committee has been diligently funding AIDS research at the National Institutes of Health for the past 20 years. He said the efforts have paid off.

“HIV is no longer a death sentence that it was in the ’80s,” Harkin said. “With the proper drugs, which by the way can now be manufactured fairly cheaply these days, people are living with it.

“I was in Africa a few years ago looking at some of our projects, and people with HIV there, as long as they take the drugs, are perfectly fine. Research has done that, even if we don’t have a total vaccine yet. These things take time, but we’ve made strides.”

A scientist at Harkin’s alma mater, Iowa State University, made headlines this month when he allegedly altered research data to indicate success with a potential HIV vaccine. The fraud helped Iowa State researchers win a $19 million grant. Sen. Chuck Grassley, R-Iowa and a top critic of federal agencies under the Obama administration, gave a July 8 Senate floor speech blasting the Iowa State case and the lack of governmental oversight to uncover and report such incidents of fraud.

The Iowa State scientist was charged with felony fraud.

Harkin dismissed the news as simply a case of occasional misconduct that shouldn’t hamper research efforts, although Grassley told reporters the case is episodic of lax oversight. Separately, in terms of AIDS research, Grassley said he is satisfied with the efforts being made by well-meaning researchers.

“We haven’t found a cure, but we’ve made great progress in the treatment of it,” he said. “I think there is a lot more that could be done in terms of education and social pressure that could bring down the incidents of it spreading. I hope we find a cure.

“But you’ve got to remember that President Nixon once declared war on cancer. And we’ve made great progress on that war, but we’ve got a long ways to go. And you’ve got to remember that money wasted on fraud like we found at Iowa State doesn’t help patients.”

The Iowa Department of Public Health is fully funded by the national Centers for Disease Control and Prevention, which has tracked the disease on a countrywide basis since it first surfaced in the early 1980s. According to the CDC, there are approximately 1.2 million U.S. citizens with either HIV or AIDS, and about 50,000 new cases of infection each year. However, the incidents of new infections is now two-thirds lower than a high of 130,000 new cases per year in the mid-1980s.

The CDC says gay men and African-American men continue to be the highest groups at-risk, and geographically the South has been the hardest-hit geographic area. The Midwest actually has the fewest amount of HIV/AIDS cases compared to the West, Northeast and South.

The fact that the disease is still so deadly becomes evident when looking at fatality numbers. More than 600,000 U.S. deaths have been attributed to the epidemic since the mid-1980s, and more than 15,000 people die in the U.S. from AIDS each year.

HIV and AIDS have squirmed into national headlines somewhat this spring and summer, with former basketball star Magic Johnson’s high-profile public argument with Los Angeles Clippers owner Donald Sterling. Just within the past few days, a world-renown AIDS researcher was killed with the downing of Malaysia Airlines Flight 17. Pim de Keijer of the Netherlands was traveling to an AIDS conference in Australia.

Harms agreed Magic Johnson has attracted considerable attention for surviving more than 20 years with HIV, but he said his case is no longer as unusual as one may think.

“We have people who don’t have Magic Johnson’s money and they’re doing quite well,” he said. “I had the same thoughts about (Johnson), but there are a finite number of anti-viral medications, and managing HIV these days has more to do with testing.”

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