National HIV Prevention and Care Objectives: 2025 Update

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Key findings

National overview

This report provides the latest data from the National HIV Surveillance System (NHSS) on care outcomes among persons with HIV. These data are used to inform program planning and monitor progress toward U.S. national prevention and care goals outlined in Healthy People 2030 and the Ending the HIV Epidemic in the U.S. (EHE) initiative. This overview summarizes the national data presented in this report.

Important notes

• Data are presented for persons with diagnosed HIV reported to CDC as of December 2024; data are provisional with a 12-month reporting delay for the assessment of diagnoses, deaths, and prevalence for the year 2023.
• Data available include stage of disease at diagnosis, linkage to HIV medical care, receipt of HIV medical care, viral suppression, deaths (any cause), survival for > 3 years after receiving an HIV diagnosis or stage 3 (AIDS) classification, and perinatal exposure.
• Small numbers, and percentages based on these numbers, should be interpreted with caution.
• Refer to the report's slide deck for figures and to the tables for national, state, and territorial-level data. Additional data, stratifications, and years can also be accessed through NCHHSTP AtlasPlus, at https://www.cdc.gov/nchhstp/about/atlasplus.html.
• See Technical Notes for information on definitions and data specifications.

Status of laboratory reporting

As of December 31, 2024, 49 states, D.C., and Puerto Rico had met the following criteria for the collection and reporting of CD4 and viral load test results:

• The jurisdiction's laws/regulations required the reporting of all levels of CD4 and viral load results to the state or local health department (Table 10).
• Laboratories that perform HIV-related testing for the jurisdiction had reported a minimum of 95% of HIV-related test results to the state or local health department.
• By December 31, 2024, the jurisdiction had reported (to CDC) at least 95% of all CD4 and viral load test results received from January 2021 through September 2024.

Idaho does not have mandatory reporting of all CD4 and viral load test results. Data for Idaho were included in national and regional analyses but are not presented in jurisdiction-level tables. Data for Puerto Rico were not included in national and regional analyses but are presented in jurisdiction-level tables. Data for Tennessee were included in all analyses but should be interpreted with caution due to a lapse in laboratory reporting that occurred during the year 2023.

Stage of disease at diagnosis

In 2023 in the United States, among 38,793 persons aged 13 years and older with HIV diagnosed during 2023, 2,847 persons (7.3% of diagnoses) received a stage 0 classification, and 8,380 persons (21.6% of diagnoses) received a stage 3 (AIDS) classification at time of HIV diagnosis.

The highest percentages of HIV diagnoses that were classified as stage 0 (recent infection) were among

• males (7.7%)
• persons aged 13–24 years (10.3%)
• American Indian/Alaska Native (9.9%) and multiracial persons (10.0%)
• persons with HIV attributed to male-to-male sexual contact and injection drug use (8.8%)

The highest percentages of HIV diagnoses that were classified as stage 3 (AIDS) were among

• persons aged ≥ 65 years (33.9%)
• Native Hawaiian/other Pacific Islander persons (35.2%)
• males with HIV attributed to heterosexual contact (33.6%)

Linkage to HIV medical care within 1 month

In the United States, among 38,793 persons aged 13 years and older with HIV diagnosed during 2023, 82.8% were linked to care within 1 month of diagnosis. The lowest percentages were among

• females (81.6%)
• Black/African American persons (80.0%)
• persons with HIV attributed to injection drug use (males: 77.6%, females: 79.4%)
• persons residing in the South at the time of diagnosis (81.2%)

Viral suppression within 6 months

Viral load was suppressed within 6 months of HIV diagnosis for 70.7% of persons with HIV diagnosed during 2023 in the United States. The lowest percentages were among

• females (69.5%)
• American Indian/Alaska Native persons (63.9%)
• persons with HIV attributed to injection drug use (males: 56.0%, females: 58.2%)
• persons residing in the South (69.3%) and West (69.2%) at the time of diagnosis

Receipt of medical care

Among 1,076,732 persons aged 13 years and older living with diagnosed HIV at year-end 2023, 76.3% received any HIV medical care (at least 1 CD4 or viral load test) during 2023. The lowest percentages were among

• females (75.9%)
• persons aged ≥ 65 years (71.0%)
• Asian (74.4%), Hispanic/Latino (74.0%), and Native Hawaiian/other Pacific Islander (73.8%) persons
• males with HIV attributed to injection drug use (61.5%)
• persons currently residing in the Northeast (73.3%)

Viral suppression

Among 1,076,732 persons aged 13 years and older living with diagnosed HIV at year-end 2023, 67.2% had viral suppression during 2023. The lowest percentages were among

• females (66.3%)
• persons aged 35–44 years (66.2%)
• Native Hawaiian/other Pacific Islander persons (62.3%)
• males with HIV attributed to injection drug use (52.7%)
• persons currently residing in the Northeast (66.1%)

Previous data releases

• Previous data releases on CDC Stacks
• NCHHSTP Atlas Plus

Technical notes

Data presented in Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data are based on case reports from the 50 states and the District of Columbia, and 6 U.S. territories and freely associated states (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands), which all have laws or regulations that require confidential reporting to the jurisdiction (not to the Centers for Disease Control and Prevention [CDC]), by name, for all persons with confirmed diagnoses of HIV infection. Information on HIV surveillance in the United States, including protocols for presentation of data by sex, age, race/ethnicity, transmission category, and geographic designations, can be found in the Technical Notes for the National HIV Surveillance System (NHSS).

TABULATION AND PRESENTATION OF DATA

1 Definitions and data specifications

1.1 Stage of disease at time of HIV diagnosis

Data on persons with diagnosed HIV, stage 3 (AIDS), include persons whose stage of disease has ever been classified as stage 3 (AIDS). These data do not necessarily represent the person's current stage of disease.

The stages of HIV infection in the 2014 case definition are based on age-specific CD4 lymphocyte counts or percentages of total lymphocytes. The 2014 case definition that describes the stages of disease can be found at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm.

Because a complete assessment of stage of disease at time of HIV diagnosis relies on complete laboratory data (all CD4 values) so that earlier stages of disease (stage 0 or 1) can be assessed, stage of disease at time of diagnosis was calculated for the jurisdictions that reported complete laboratory data.

Information on stage 3 (AIDS) is available for all 50 states, the District of Columbia, and 6 U.S. territories and freely associated states, even when not all CD4 values are reportable; therefore, stage 3 (AIDS) at time of HIV diagnosis was calculated for persons in all areas.

Stage of disease at time of diagnosis (i.e., HIV infection, stage 0, 1, 2, 3 [AIDS], or unknown) were determined by using the first CD4 test result or documentation of an AIDS-defining condition ≤ 3 months after the HIV diagnosis date during the most recent year, unless documentation indicated disease stage 0. If ≥ 2 events occurred during the same month and could thus qualify as "first," the following conditions were applied:

• If an AIDS-defining condition was documented, the AIDS-defining condition was used; if a CD4 count or a CD4 percentage had been reported and an AIDS-defining condition was documented, the AIDS-defining condition was used.
• If an AIDS-defining condition was not documented, but a CD4 count and a CD4 percentage had been reported, the CD4 count was used.
• If an AIDS-defining condition was not documented, but > 1 CD4 count had been reported, the lowest CD4 count (indicative of the most severe disease state) was used.
• If an AIDS-defining condition was not documented and a CD4 count had not been reported, but a CD4 percentage had been reported, the CD4 percentage was used. If > 1 CD4 percentage was reported, the lowest CD4 percentage (indicative of the most severe disease state) was used.

For stage of disease at time of diagnosis, HIV was classified as "stage unknown" if the month of HIV diagnosis was missing, or if, > 3 months after HIV diagnosis, neither a CD4 count nor a CD4 percentage had been determined and no AIDS-defining condition was documented.

1.2 Linkage to, and receipt of, HIV medical care

The data on linkage to HIV medical care were based on persons with HIV diagnosed during the specified year. Linkage to HIV medical care within 1 month of HIV diagnosis was measured by documentation of ≥ 1 CD4 (count or percentage) or viral load tests performed within ≤ 1 month of HIV diagnosis, including tests performed on the same date as the date of diagnosis.

The data on receipt of HIV medical care were based on persons with HIV diagnosed by the end of the previous calendar year, who were alive at the end of the specified year. Receipt of any HIV medical care was measured by documentation of ≥ 1 CD4 or viral load tests performed during the specified year. Retention in care (receipt of continuous HIV medical care) was measured by documentation of ≥ 2 CD4 or viral load tests performed ≥ 3 months apart during the specified year.

For analyses of linkage to, and retention in, care, the month and the year of the earliest HIV-positive test result reported to the surveillance system were used to determine the diagnosis date. Test results were excluded if the month of the sample collection was missing. For linkage to care, data were excluded if the month of diagnosis was missing.

1.3 Viral suppression

Viral suppression within 6 months of diagnosis was measured for persons with HIV diagnosed during the specified year. Viral suppression was defined as a viral load result of < 200 copies/mL at any viral load test within 6 months of an HIV diagnosis made during the specified year.

Viral suppression was measured among persons with HIV diagnosed by the end of the previous calendar year, who were alive at the end of the specified year. Viral suppression was defined as a viral load result of < 200 copies/mL at the most recent viral load test during the specified year. The cutoff value of < 200 copies/mL was based on the following definition of virologic failure: viral load of ≥ 200 copies/mL. If multiple viral load tests were performed on the same day and could thus qualify as "most recent," the viral load result of < 200 copies/mLwas selected. If the numerical result was missing or the result was a logarithmic value, the interpretation of the result (e.g., below limit, not detected) was used to determine viral suppression. Virologic failure may indicate lack of adherence to antiretroviral therapy (ART).

1.4 Death

Monitoring receipt of HIV medical care, retention in HIV medical care, viral suppression at most recent test, death (any cause), and survival of persons with diagnosed HIV is dependent upon complete death ascertainment conducted by HIV surveillance programs for reporting to CDC. Due to incomplete reporting of deaths, death data should be interpreted with caution for areas with incomplete reporting for the most recent data year.

More information on deaths can be found in the Technical Notes for NHSS, available at https://www.cdc.gov/hiv-data/nhss/index.html.

1.5 Survival analyses

The Kaplan-Meier method was used to estimate the probability of survival for > 3 years (36 months) for persons with diagnosed HIV and for persons whose stage of disease has ever been classified as stage 3 (AIDS). To allow ≥ 3 years from the time of HIV diagnosis to a death date on or before the end of the most recent data year, tables were limited to data on persons whose HIV diagnosis or stage 3 (AIDS) classification was made 3–8 years before the most recent data year. The results of survival analyses for areas with < 100 diagnoses per year (i.e., 600 during the 6-year period) were unstable and therefore are not presented.

2 Rates

Rates were calculated for the numbers of deaths of persons with diagnosed HIV and diagnoses of perinatally acquired HIV among persons born in the United Sates.

2.1 Rates of deaths (any cause)

In tables displaying data on deaths of persons with diagnosed HIV and deaths of persons with HIV ever classified as stage 3 (AIDS), rates were calculated in 3 ways:

• Rates of deaths per 100,000 population: Each rate was calculated by dividing the total number of deaths for the calendar year by the population for that calendar year and then multiplying the result by 100,000.
• Rates of deaths per 1,000 persons living with diagnosed HIV or living with HIV disease ever classified as stage 3 (AIDS): Rates were calculated by dividing the reported total number of deaths of persons with diagnosed HIV (or with HIV classified as stage 3 [AIDS]) during the calendar year by the sum of the number of persons living with an HIV diagnosis (or with HIV classified as stage 3 [AIDS]) at the end of the previous calendar year plus the number of HIV diagnoses (or stage 3 [AIDS] classifications) during the current calendar year; the result was then multiplied by 1,000.
• Age-adjusted rates of deaths per 100,000 population and per 1,000 persons living with diagnosed HIV or living with HIV disease ever classified as stage 3 (AIDS): Age-adjusted rates by area of residence in addition to crude rates. A standard population distribution was used to adjust death rates per 100,000 population and per 1,000 persons living with diagnosed HIV (or with HIV disease ever classified as stage 3 [AIDS]). The age-adjusted rates are rates that would have existed if the age distribution of the designated population and the age distribution of the standard population were the same. The use of the U.S. year 2000 standard population in calculating age-adjusted rates was based on recommendations by the National Center for Health Statistics [1, 2].

2.2 Rates of diagnosis of perinatally acquired HIV

Perinatally acquired HIV rates were calculated per 100,000 live births.

Suggested readings

1. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep 1998;47(3):1–16, 20. https://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf. Accessed April 28, 2025.

2. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes 2001;(20):1–9. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf. Accessed April 28, 2025.

Acknowledgements

HIV Surveillance Branch
Division of HIV Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention

Publication of this report would not have been possible without the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC.

Suggested citation

All material contained in this report is in the public domain and may be used and reprinted without special permission; however, citation of the source is appreciated.

Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Territories and Freely Associated States, 2023. Centers for Disease Control and Prevention. Published April 29, 2025. Accessed [date]. https://www.cdc.gov/hiv-data/nhss/national-hiv-prevention-and-care-outcomes.html

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