Study: Early Initiation Of HIV Treatment Dramatically Reduces AIDS, Other Adverse Events

By |2015-06-04T09:00:00-04:00June 4th, 2015|Michigan, News|

Scientists ended a multi-year study, funded by the National Institutes of Health, 18 months early because it showed those who started anti-HIV therapies reduced the risk of death or development of AIDS by half. The evidence, they say, shows initiation immediately upon diagnosis should be a standard of care and that it confers significant benefits on the health of persons living with HIV.
Dr. Peter Gulick, an infectious disease doctor with patients in Lansing, Harrison Township and Saginaw, hailed the findings.
“I totally 100 percent agree” with the findings, he said in a phone interview. He said early initiation can not only prevent the virus from destroying the immune system, but can address the chronic inflammation the infection causes. That inflammation can contribute to widespread issues such as heart disease as well as impact the kidneys and liver.
Current medical guidelines from the federal government recommend initiation of anti-HIV medications for those infected with the virus when their immune function has been somewhat impaired. But following the announcement of the end of the study, federal HIV experts hailed the findings.
“We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later,” Anthony S. Fauci, M.D., director of the National Institute of Allergies and Infectious Disease, said in a press release. “Moreover, early therapy conveys a double benefit, not only improving the health of individuals but at the same time, by lowering their viral load, reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV.”
But doctors knowing that early treatment will result in better outcomes for people living with HIV may have trouble translating that to people living with HIV.
The advantages of HIV treatment have long been known but those who know they are living with the virus in Michigan are not availing themselves of care and treatment, according to a 2015 report from the Michigan Department of Community Health. Only about 38 percent of the population that is infected and knows has achieved viral suppression.
Viral suppression, commonly referred to as undectable viral loads, is a medical measure of the number of viral particles in the blood. The measures used in Michigan generally can detect as few as 28 viral particles per milliliter of blood. Anything less than that is considered “undetectable.” Studies have shown undetectable viral loads lead to healthier outcomes for people living with HIV. They have also shown that they make a person living with HIV significantly less likely to transmit their virus to another person.
Data from 2013 shows that over 18,000 people are living with the virus in the state. Of those, over 15,000 have been diagnosed. Of those who know they are living with the virus, just over 7,500 are in continuous HIV medical care, while just over 6,000 of those have suppressed their virus.
Additional data shows achieving viral suppression can be a function of geography in the state. For instance, in Flint and Benton Harbor areas, only about 20 percent of people living with HIV have achieved viral suppression, while in Lansing and Grand Rapids areas those numbers fall closer to 40 percent. In Metro Detroit, which accounts for the largest number of infections in the state, about 35 percent of people living with HIV have achieved undetectable viral loads.
Gulick, the HIV specialist who has been treating the epidemic since it was identified in 1981, said accessing and maintaining medical care for people living with HIV is often fraught with obstacles. Among those obstacles, he said, are mental health issues, transportation, internalized stigma and substance abuse issues.
He told the story of a patient struggling with depression. That patient has difficulty taking the anti-HIV drugs every day, something that is required to not only keep the virus at bay, but to prevent it from becoming immune to the drugs, because he often is hopeless.
“He has to have that underlying mental health issue addressed before he can deal with the HIV,” Gulick said of the patient.
The state has currently funded several grants for agencies across Michigan to work on assisting people living with HIV to get into care and remain there. Such programs will become “one stop shops” for medical care, including dental and mental health services.
Another obstacle for people living with HIV is access to affordable medical care and treatments. Anti-HIV medications can cost thousands of dollars a month, and while many are covered by health insurance policies, some insurance companies have put the drugs in specialty categories, forcing people living with HIV to pay 20 percent co-pays for the medication.
Jennifer Smith, the Michigan Department of Community Health spokesperson, says the 2014 implementation of the Affordable Care Act, combined with the expansion of Medicaid eligibility in the state and the state health insurance exchange, have “dramatically changed the landscape” of how federal HIV care dollars and programs are operating.
One such program is the AIDS Drug Assistance Program, or ADAP. That program will help those with gross income at or below 450 percent of the Federal Poverty Level pay for their anti-HIV drugs and other medications that assist in addressing HIV, such as medications to treat various infections. The state currently assists 2,600 living with HIV through this program. But Smith said the state is prepared to absorb more clients in the program.
“As individuals become aware of their HIV status and obtain treatment, MIDAP will continue to absorb all clients who meet the eligibility requirements,” she wrote in an email to Between The Lines. “Michigan will be able to absorb increases, if any, in the next two years.”
She does warn, however, that as cases increase in the state, funding may have to increase for the program, which is funded through the Ryan White CARE Act and pharmaceutical company rebates.
“As prevalence increases, continued ‘ADAP earmark’ funding will be central to supporting people with HIV at each stage of the treatment cascade (from diagnosis to viral load suppression) to ensure reduction in mortality/morbidity and improvement in disease prognosis,” she wrote.

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