2012 AIDS meeting: Early treatment is key, experts say

Treat HIV now, don’t delay: That’s the new advice from the International Antiviral Society-USA, in a shift from earlier recommendations that called for waiting until a patient’s immune system showed serious damage.

Studies show that treating HIV-positive patients with antiretroviral drugs early in the course of the infection lengthens life and lowers the risk of tuberculosis and other bacterial infections, the panel noted in a JAMA paper, which was published to coincide with the start of the International AIDS Conference in Washington.

The medications can also reduce transmission of the virus to sexual partners by 96%, the panel noted. Treatment, in other words, can double as prevention.

Adults infected with HIV should be offered treatment even if their immune systems are still relatively intact, the panel added.

The recommendations are intended for wealthy countries where antiretroviral treatments are readily available; the U.S. Department of Health and Human Services released similar guidelines in March that advise treatment for all people with HIV.

Yet despite the growing consensus on the benefits of early treatment, people who inject drugs are consistently denied this option, said Dr. Nora Volkow, director of the National Institute on Drug Abuse, speaking at the AIDS conference Sunday.

Volkow noted that 70% of injection drug users receive treatment later than non-drug users, according to studies. Doctors are reluctant to start HIV treatment for them because they fear they won’t stick with the daily drug regimen -- and that could coax HIV to develop resistance to the medications.

But research shows that injection drug users are just as likely as non-drug users to properly manage their HIV medication if physicians treat patients’ substance abuse at the same time as their HIV infection, Volkow said, citing work by researchers in British Columbia.

And, she said, turning the HIV/AIDS epidemic around cannot be done without addressing this key group.

Numerous speakers in the opening days of the conference credited science -- in particular, antiretroviral drug therapies -- with changing an HIV diagnosis from a death sentence into a manageable chronic illness.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said we now have a scientific foundation to even consider the feasibility of an “AIDS-free generation.”

“We have a stunning amount of advances in the area of basic and clinical research,” Fauci said. “We know a lot about this virus.”

Probably the most important knowledge is understanding how HIV replicates, Fauci said. “This has given us targets of vulnerability on the part of the virus” that future antiretroviral drugs can exploit.

Fauci said science has brought us a long way from the early “dark days” of the epidemic, when his patients would die within weeks or months. Now, if a 25-year-old contracts HIV and starts treatment right away, Fauci said, he can look that patient in the eye and tell him or her they can live an additional 50 years -- essentially, a near-normal life span.

The drugs have helped an increasing number of HIV-positive patients keep virus levels low in their bodies, another JAMA study found. The survey of 32,483 HIV patients receiving antiretroviral therapy in 12 clinics around the country reported that just 45% had low levels of virus in 2001, compared with 72% in 2010. More tolerable drugs, improved drug adherence and better access to healthcare may have contributed to this improvement, the authors said.

But although statistics like that are encouraging, Fauci noted that only 36% of people infected with HIV in the United States regularly take antiretroviral medication, and as a result only 28% of HIV-positive people in this country have low levels of virus in their bodies.