Majority of Americans with HIV Are Not Getting Optimal Care

In a November 29 article in the Washington Post, it was reported that only slightly more than a quarter of HIV-positive Americans are getting the kind of medical care that maximizes their life expectancy, according to a new estimate from the Centers for Disease Control and Prevention (CDC).

The goal of HIV treatment is to suppress the virus until it is no longer detectable in the bloodstream. Only 28% of the 1.2 million people living with HIV in the United States have their viral load controlled to that optimal degree, according to epidemiologists at the CDC.

 “It is time to act even more aggressively,” said Jonathan Mermin, MD, director of the CDC’s Department of HIV/AIDS Prevention. Having such a small fraction of people adequately treated “is not acceptable from a public health, humanitarian, or economic perspective,” he said.

Several years ago, the CDC endorsed universal HIV testing of Americans. With new research showing that treated people are unlikely to transmit the virus to others, the agency is campaigning for physicians and health departments to make sure that people who are found to be HIV-positive get into treatment. For those who enter and stay in care, approximately 77% achieve undetectable viral loads. However, the CDC reports that as many as 50% of those who enter care, end up dropping out.

While high rates of attrition from treatment can be common due to reluctance to take pills, drug side effects, inconvenience, expense, and denial, studies have shown that 32% of Latinos, 21% of blacks and 16% of whites are uninsured, potentially creating an obstacle to HIV treatment. This is not likely to improve with the current political climate and proposed cuts to Medicare and Medicaid.


NYC Health Officials Recommend AIDS Drugs for Any Person with HIV


Health officials in New York City are recommending that any resident living with HIV be offered AIDS drugs as soon as the virus is diagnosed, an aggressive move that has been shown to prolong life and stem the spread of the disease, according to an Associated Press report on on December 1. San Francisco is the only other city known to have made such a recommendation, in 2010.

New York City Health Commissioner Thomas Farley said recent studies have shown that the benefits of early treatment, combined with education and testing, appear to be a promising strategy for countering the epidemic.

City health officials said the new recommendation could initially help about 3,000 people get on medications. About 66,000 New Yorkers living with HIV that the Health Department tracks are being effectively treated with AIDS drugs, they said. But they said it was difficult to estimate how many people would eventually need the medications.

Some doctors agree with the Department of Health that it is time to update the guidelines for initiating AIDS drug treatment.

Dr. Joel Gallant of Johns Hopkins University School of Medicine and vice chair of the HIV Medicine Association also agrees with the New York recommendation for offering early treatment. He recommends early treatment for his own patients.

“Nobody I know who is an HIV expert feels that it’s a bad idea to treat HIV at high CD4 counts from a medical or scientific standpoint,” Gallant said. “If there are objections, they’d usually be based on cost or feasibility.”

Cost questions are important because brand-name drugs can retail for $1,200 to $1,600 per month. City health officials said they anticipate that the cost for expanding the use of AIDS drugs would be covered by private insurance or by the AIDS Drug Assistance Program (ADAP). The officials said they expect the benefits over the long term would far outweigh the initial costs because there would be fewer hospitalizations and new HIV cases.

Dr. Moupali Das, the director of research at the San Francisco Department of Health HIV Prevention Section, said its surveillance data indicated that physicians were treating their HIV patients early even before the city recommended doing so. She said they are currently analyzing what has happened since the recommendations went into effect. But, anecdotally, she said that there has been a change among patients seeking treatment. “It’s changed the dialogue and empowered our patient population,” she said.

“What we’re doing here is we’re making a really clear and unequivocal statement that we think this is good for the health of the patient, good for the health of the entire population, good for the response to the epidemic,” Farley said