Benefits Of Early HIV Testing and Treatment Are Clear
0The benefits of getting tested for HIV and starting antiretroviral treatment as soon as possible after an HIV-positive diagnosis are clear, a prominent HIV/AIDS specialist said Aug. 24 at the Center on Halsted.
Dr. James Sullivan, who's treated HIV patients at Saint Joseph's Hospital in Lakeview for 15 years, said studies indicate that people who start ARV treatment early, even when their HIV viral loads are undetectable and their CD4 counts are high, may live as long as their HIV-negative peers.
"The life expectancy is really coming close for certain sub-groups to what would be considered normal," Sullivan said.
Research on 25 cohort studies in Europe involving more than 80,000 HIV-positive patients showed that patients not compromised by IV drug use had normal life expectancies after ARV treatment enabled their CD4 counts to climb above 500.
Research such as that has led Sullivan and other HIV specialists, along with the U.S. Centers for Disease Control and Prevention, to recommend starting ARV treatment at far earlier stages than used to be recommended.
"A majority of people, even above 350, should be treated, even though that's not official policy yet," Sullivan said. "Several large cohort studies have shown the benefit of starting treatment when the count is over 350."
While the research is incomplete, Sullivan said people who test positive for HIV should probably begin taking ARV drugs even if their CD4 counts are above 500, which is considered to be a normal count for adults who are not affected by HIV. The longer people wait before getting treated, Sullivan said, the harder it is for their immune systems to recover when they do begin treatment. That's even more true for older people, he added.
"The T-cells they lose, they're less likely to get back than a younger person," Sullivan said.
The mounting data on the benefits of early ARV treatment, he said, point to another obvious conclusion: People need to get tested early and often, especially gay and bisexual men.
"HIV-negative men who have sex with men should be tested annually," Sullivan said.
They should also get tested when other indications are present, such as unexpected bouts of fever or other acute symptoms that may indicate recent HIV infection. Sullivan said he, along with the CDC and many HIV specialists, believe HIV testing should become a routine part of most medical encounters, including testing all persons ages 18-65 in any outpatient setting and all pregnant women.
The testing should be "opt-out," he said, a recommendation the CDC is advocating, which means consent would be implied by consent to medical care, with no special forms or HIV prevention counseling required. Patients who don't wish to be tested would have to take the initiative to refuse testing.
Requiring that in Illinois, however, would necessitate changes in state law that currently mandate specific counseling and consent forms in order for an HIV test to proceed.
Sullivan said studies indicate that more widespread HIV testing and, consequently, earlier HIV treatment with ARV drugs appears to be slowing the spread of HIV/AIDS. A syphilis epidemic among gay men in the U.S. in recent years, he said, indicates that gay men are having more frequent unprotected sex than in years past.
"We're all pretty confident that there's more sex, and more unsafe sex, going on," Sullivan said.
That's evident in large cities such as Chicago, he said. But despite that, HIV incidence among gay men is remaining stable, he added, "even falling a little bit in some communities."
Sullivan attributed that to wider and earlier use of ARV drugs. And in San Francisco, he said, where more detailed statistics are kept on HIV, evidence indicates that community's overall viral load is decreasing because of the use of ARV drugs.
"The community viral load has been falling in San Francisco over time," Sullivan said. "And the rate of HIV has been falling."
People shouldn't shy away from using ARV drugs as soon as possible after a positive HIV test, he said, noting that the side effects of such drugs have become much more manageable in recent years. Many ARV regimens only require one pill a day now, in contrast to the complicated regimens of the past. And, Sullivan added, ARV treatment appears to lessen mortality from causes not normally related to HIV infection in people who carry the virus.
"I believe, and so do most doctors in this field now, that the virus is worse than the treatment," Sullivan said.
Even with advances in treatment, he cautioned, gay men should continue to use condoms. It's a myth, Sullivan said, that an undetectable viral load in an HIV-positive person means they won't transmit the virus to partners.
"Even when your viral load is undetectable, there's virus in your semen," he said.
The Center on Halsted, 3656 N. Halsted, with support from the Illinois Department of Public Health, offers free anonymous or confidential HIV testing seven days a week, 8 a.m. to 9 p.m. Results are available in just 20 minutes. The Center also offers eight free counseling sessions to people who test HIV-positive. Assistance and information is available in English or Spanish. For more information call the AIDS/HIV and STD Hotline, 8 a.m. to 10 p.m. everyday, at 800-243-2437. The Chicago Department of Public Health, Howard Brown Health Center and others also offer free HIV testing.