HIV Patients Should Start Drug Treatment Right Away, New Guidelines Say

  • Share
  • Read Later
Francis Sheehan / Getty Images

Thousands of scientists, doctors, policymakers and people living with HIV are meeting this week for the annual International AIDS Conference in Washington, D.C., the first time the conference is being held on U.S. soil in 22 years.

The goal is to try to turn some crucial advances in HIV research into practical measures to save lives. In recent years, studies have found, for example, that using HIV treatment drugs can prevent infection in healthy people; that circumcising men can protect them from HIV; and that treating patients early, before they become sick, reduces the risk that they’ll infect others with the virus.

‘‘Future generations are counting on our courage to think big, be bold and seize the opportunity before us,’’ Dr. Diane Havlir of the University of California, San Francisco, a co-chair of the International AIDS Conference, told the AP.

(MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be)

To coincide with the conference, this week’s issue of the Journal of the American Medical Association (JAMA) is devoted to new research on HIV. One study, focusing on the benefits of early treatment, issues new recommendations for adults with HIV, advising that all patients be treated immediately potentially life-saving antiretroviral medications, or ARVs.

The new guideline comes from the International Antiviral Society-USA panel, and revises current recommendations, which advise that drug treatment should begin when levels of patients’ immune cells, known as the CD4 count, drop below 350 cells per mm3 of blood. The new guidelines initiate treatment immediately, regardless of a patient’s CD4 count.

The panel says that it revised its advice for ARV treatment based on studies conducted over the past two years, which show that patients at all stages of infection may benefit from drug treatment. In particular, trials in which HIV-positive patients began ARVs soon after infection showed that they could lower their risk of tuberculosis, bacterial infections, other AIDS-related complications and even death from the disease by 41%, compared with those who waited to start therapy later, when their CD4 counts dropped to 350. In another study, those who began drug treatment at CD4 counts of 350 had a 38% increased risk of developing full blown AIDS and dying prematurely of the disease than those who didn’t wait as long to start ARVs.

(MORE: HIV Continues to Spread Among Gay Men, Studies Show)

The question of when to initiate ARV has always been a tricky one for AIDS clinicians; because the drugs have serious side effects, doctors must balance their potential life-saving benefit against these adverse events, including cancer and lipid imbalances. But with advancements in drug development, newer therapies that are easier to take have made it possible to start patients earlier, and when it comes to confronting HIV, experts say, the sooner the better.

The guidelines include recommendations for which drug combination newly infected patients should receive. The combinations include a cocktail of four medications that all hit HIV at different points in its life cycle: two nucleoside reverse transcriptase inhibitors, a non nucleoside reverse transcriptase inhibitor, along with either a ritonavir-based protease inhibitor or an integrase inhibitor.

Starting drug treatment for all HIV-positive patients may also have another benefit — recent trials have hinted that hitting the virus hard with anti-HIV medications soon after a person is infected may hamper HIV’s ability to jump from that patient to a new host during sexual contact. If that’s the case, then the new guidelines may also help to reduce transmission of the disease. “There is no CD4 cell count threshold at which starting therapy is contraindicated,” the authors write.

(MORE: Truvada: 5 Things to Know About the First Drug to Prevent HIV)

In the other papers appearing in the JAMA theme issue, scientists report:

Differences in foreign-born and U.S.-born HIV patients in the U.S.
Among the 191,697 people diagnosed with HIV and living in the U.S. between 2007 to 2010, 16% were born outside of the U.S. The four states reporting the highest numbers of people born outside the U.S. and diagnosed with HIV (California, Florida, New York and Texas) were also the top four states with HIV cases overall.

Nearly 40% of foreign-born, HIV-positive patients were infected via heterosexual contact, compared with 27% of U.S.-born patients. For men born either in the U.S. or in another country, the majority of HIV diagnoses were in men who have sex with other men.

By race or ethnicity, the proportion of HIV patients born outside the U.S. varied: among white patients, 3.3% were born outside the U.S.; of black patients, 10% were born outside the U.S.; of Hispanics, 42.2% were foreign-born; and among Asians, 64.3% were not born in the U.S.

Of the 25,255 people diagnosed with HIV who specified a country or region of birth outside the U.S., the most common region of birth origin was Central America (including Mexico, 41%), followed by the Caribbean (21.5%), Africa (14.5%), Asia (7.9%), and South America (7.6%).

Although 95% of patients with HIV live outside the U.S., public health experts say it’s important to understand the socioeconomic characteristics of those who are foreign-born and affected by HIV and living in the U.S., to better target prevention and treatment programs that are more effective and culturally meaningful.

Hope for an AIDS-free generation
Pointing to the continued evolution in ARVS, as well as the latest understanding that the drugs can help protect healthy, uninfected people from HIV infection, authors Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Gregory Folkers, also of NIAID, provide hope that eventually HIV may be a scourge of the past.

ARVs have saved an estimated 700,000 lives in 2010 alone, the authors write, but additional efforts to prevent new infection can help push that number higher. Among the strategies, say Fauci and Folkers: use ARVs to prevent infection (the U.S. Food and Drug Administration approved this month the first anti-HIV drug for prophylactic use in uninfected, high-risk people); establish stronger programs to prevent transmission of HIV from pregnant women and mothers to their children; encourage male circumcision to reduce HIV transmission during sexual contact in developing nations. Combining these strategies will be essential to developing an action plan against HIV, the authors say.

“With collective and resolute action now and a steadfast commitment for years to come, an AIDS-free generation is indeed within reach,” they write. “Achieving this goal, however, will require implementing a multifaceted global effort to expand testing, treatment and prevention programs, as well as meet the scientific challenges of developing an HIV vaccine and possibly a cure.”

MORE: Free HIV Tests May Be Coming to a Drug Store Near You

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

13 comments
MariaAThompson
MariaAThompson

Hello my good friends please do not see this strange cause it my life story about my healing, i was having HIV for good 6yrs. Things were not working fine for me due to my health status i know longer have friends know lover it even takes time before my family co-operate with me due to this i tried all possible means i can to get this devilish sickness out of my body i went to hospitals churches and other heath organization but all remains the same till yet i never gave up cos i was not born with this illness so i decided to take it over to the internet to see if i could get remedy, on my search i saw a testimony of a woman, she said she was also having a terrible sickness for over 3yrs but now she is healed i was surprise at first when i saw her test so she wrote a name Dr Molemen and also gave his email id so i mailed them which is (drmolemenspiritualtemple@gmail.com) i told them about my problem and after the processes he told me that am healed but i never believed he told me to go and confirm it from the hospital were i have been taking treatment still i never believed also although he gave me evidence that the sickness was gone.
Finally i decided to go for check up and to my surprise my doctor said the sickness was know longer there with thought of joy i started shearing tears.
My friends today am now married bless with 2kids, so if you have any sickness kindly email (drmolemenspiritualtemple@gmail.com)  or call him on (+2347036013351)sir i will forever remain in you debt.
Thank you sir am grateful               

MariaAThompson
MariaAThompson

Hello my good friends please do not see this strange cause it my life story about my healing, i was having HIV for good 6yrs. Things were not working fine for me due to my health status i know longer have friends know lover it even takes time before my family co-operate with me due to this i tried all possible means i can to get this devilish sickness out of my body i went to hospitals churches and other heath organization but all remains the same till yet i never gave up cos i was not born with this illness so i decided to take it over to the internet to see if i could get remedy, on my search i saw a testimony of a woman, she said she was also having a terrible sickness for over 3yrs but now she is healed i was surprise at first when i saw her test so she wrote a name Dr Molemen and also gave his email id so i mailed them which is (drmolemenspiritualtemple@gmail.com) i told them about my problem and after the processes he told me that am healed but i never believed he told me to go and confirm it from the hospital were i have been taking treatment still i never believed also although he gave me evidence that the sickness was gone.
 Finally i decided to go for check up and to my surprise my doctor said the sickness was know longer there with thought of joy i started shearing tears.
    My friends today am now married bless with 2kids, so if you have any sickness kindly email (drmolemenspiritualtemple@gmail.com) sir i will forever remain in you debt, you can call him on +2347036013351
Thank you sir am gratefull               

JaneWembli
JaneWembli

Well all I can say is what I witness and what happen to me also thanks to the doctor would help me out with hiv/aids cure I always think am useless since I have this hiv I was not myself but thanks to the great DR.UGBAKHUAN would bring me out of the sorrow, one of my friend who was cure by this great doctor introduce me to him am and give me, his email, my friend inform me about the necessary things for the cure because she was also cure by him I was so happy when my friend show me her result I believe on this without know him I believe this man will also help a poor lady like me, will were on the issue on till final the man was free to attend to me I tell he everything how I get the hiv, and the time, and also inform him that it was a friend that introduce me to him the man was so happy my friend stay to his promise, as he also help me and also ask me to do what my friend did well for me I think the good and wideness place to share the good news is internet, and I bring my own here am here to inform you all that will are save with doctor UGBAKHUAN the only man that I witness he cure hiv/aids this man emails are ugbakhuanspelltemple

JacksonRex
JacksonRex



Hello my name is Julia I want to give
a testimony about my HIV virus that
was cured by a great spell caster.
Since last 4 months I have being a
HIV AID patient. I never think I live
long again and am so grateful about
him {TOROTOSPELLSPELL@YAHOO.COM} who cured my HIV
AIDS last 3 weeks. I was in a great
pain so I told one of my best friends;
he told me that there is a great spell
caster that can cure my HIV. I asked
her if she had his email, she gave me
his email, I emailed him he talked to
me and he perform the necessary
rituals and he told me that after two
weeks I should go for a test. Which I
did, when the doctor told me that am
now a HIV negative I couldn’t believe
myself I went to see another doctor
the result was still the same, I was
human on planet earth, so I emailed
him and thanked him. Please if you
are having a similar problem please
visit him/contact him on email {TOROTOSPELLSPELL@YAHOO.COM}{+44-7053854159]

MorganDanielle
MorganDanielle

my name is mariam baurice from south Africa...i saw this comment on positive blogs and i will love to tell every body how my status changes to negative, and am now a living witness of it and i think its a shame on me if i don't share this lovely story with other people infected with this deadly virus...,hiv has been ongoing in my family... i lost both parents to hiv,. and it is so much pain ive not been able to get over.. as we all know medically there is no solution to it..and medication is very expensive. So someone introduced me to a native medical practitioner in africa..i had a job there to execute so i took time to check out on him.i showed him all my tests and results.. i was already diagnosed with hiv and it was already taking its towl on me.. i had spent thousands of dollars so i decided to try him out...i was on his dosage for 3 weeks. although i didnt believe in it, i was just trying it out of frustration... and after 2 weeks, i went for new tests... and you wont believe that 5 different doctors confirmed it that am negative..it was like a dream,,i never believe aids has cure..am now negative,,am a living witness..i dont know how to thank this man... i just want to help others in any way i can..have joined many forums and have posted this testimonies and alot of people has mail and called this man on phone and after 2 months they all confirmed negative..bbc news took it live and every.. hope he helps you out.. everybody saw it and its now out in papers and magazines that there's native cure for hiv and all with the help of this man,,have tried my own parts and all left with you,,if you like take it or not..god knows have tried my best.about 97 people have been confirmed negative through me..and they send mails to thanks me after they have been confirmed negative,,this man is real..don't miss this chance,,hiv is a deadly virus,,get rid of it now.. DR.ABEGBESPELLHOME@HOTMAIL.COM OR DR.ABEGBESPELLHOME@GMAIL.COM  +2348113017989

elninosantos1
elninosantos1

Thank to dr. cuba for his good work I really believe HIV have cure I was HIV positive over since 1year plus before I come across a comment dr.cuba that he have cure to any disease and virus but when I saw it i have it in mind that he can’t cure HIV I just decided to give a try I contact him that night lucky to me he said yes but I don’t believe him I think it was a scam or some thing like that but I still hold on to see the work of dr.cuba if he is saying the true he ask for different things and some question about me I give him all the detail he needed and I wait to see his reply to my problem after all the things is done he ask me to go for check up I went for hiv test I cant believe I was negative the midical doctor was surprasie and doctor even ask for dr cuba email which i give to him, he he is help people that contact him also he can still help you on your cure thanks dr.cuba for helping me for the cure at this young age if you need help contact him now Dr.cubatemple@gmail.Com call +2348062477418

JoseInaler
JoseInaler

hello, my name is Jose from united kingdom, i want to share this wonderful testimony to you guy in case you are in this same problem. i was suffering from HIV/AIDS for 1 year and 9 months until i meant Doctor Aluta who counseled me and told me he could cure me, i never believed him, i thought that there was never a cure for my deadly ailment. Doctor Aluta told me that his herbs could cure me, and then i decided to give it a try, he told me that once i start taking it, that it will only take me some days to be cured, and i believed him, after he gave me the medicine, behold i took it and i was cured in just 3 days, i even went for a test to confirm it and now i am very happy to tell you that i am now HIV/AIDS negative and i am also happy that i will not be celebrating this Christmas as a HIV/AIDS patient, so help me say a very big thank you to Doctor Aluta and God for saving me from the hands of the deadly ailment, if you also need help in this type of issues you are very free to contact him today through his private email: alutaspelltemple@hotmail.com  or call him on his mobile number : +2348077526430.

MichelKelvin
MichelKelvin

He that work and never ask for anything thanks dr ariba for good work for healing my brother for HIV sickness he was very sick for a year + and my daddy have spend so much money on medical care and drug he have being taking to some many place for healing… even different pastor have pray for him it get worse every 6hous the man that heal with 45mins is here the man that the lord god have giving the power to put every thing in place the man that give a word and never fail my kid brother was just chatting one day when he see this post ofjack about the curing of HIV virus by DR ARIBA he run to my daddy and tell him about the man my daddy decided to call him and confirm it if it is true about the cure the man just assure him about his work that the great power of is for father and his gods cure any disease include HIV/AID, Ebola, Rota virus, Smallpox ,Hepatitis well we have hope on him which we give a try to after 45 mins my big brother started getting better as am write this comment his is at work now what a miracle….. if you need help from DR ARIBA contact him now my friend through his email or phone number draribaspelltemple@gmail.com or dr.aribaspelltemple@outlook.com or call +2348163979933

VivieLoxton
VivieLoxton

Am from CANADA, am here to give my testimony about how i got my HIV disease and how I was flew from it quickly after having on trust on my spell doctor who cured me immediately. Since the year I married to the man I did love because my parents false me to marry him, I have not been enjoying my relationship and sex life with him, he do spend time on his work and don’t have time for me sometimes, he do sleep at his work and also do carry women’s because he has the money to spent but doesn’t spend it on me. So I was so jealous to the extent that I can’t even control my anger and I decided to start cheating on him with my ex-boyfriend, because my husband do not always be at home expect on weekends, I have sex with him without protection, after some months been in love with my ex-boyfriend I was so sick and I decided to go to test and I found that I was HIV positive I feel so sad and was ashamed because I did know how to open up  to my husband I hate before, my ex-boyfriend denied me and when my husband found about what was going on he divorced me and I was ill for good  3years I went to many places for solutions but there was no solutions. So one day I was asking GOOGLE some questions on how I can get a cure and how I can get some medications which I will be taking to my own surprise they brought one email out named DR.ABEGBESPELLHOME@HOTMAIL.COM  that this powerful man can cured HIV, I did believe about the cure before but I took the email and searched it on GOOGLE and I found many good testimonies about him, people have been giving more testimonies about him so i  contacted him about my situation, he told me all the procedures which I will take, And I did before I knew what was happening he called me and told me to go for an HIV test which i did and when the result was out I was HIV negative. Thanks to DR.ABEGBE now as I am giving this testimony I am now fully settle down with my husband now and we both loved ourselves, I give this testimony for people around that was in my shoes so that they can also be cured like me, so if you also need a solution also you can email him at DR.ABEGBESPELLHOME@HOTMAIL.COM 

MichelKelvin
MichelKelvin


Hello every body, Miss Rose, and i am here to testifies on how DR ARIBA  help me to cure my sickness called HIV/AIDS which has been eating me up for 2years and 4months, and when I go online I saw his email on how he cured so many people, so I emailed the Dr and tell my problems to him, and tell all his necessary needy for the healing, after that day he gave me an assurance of 4days of his herbal healing, and said I should go for a medical check up on the 5th day of which I get to the hospital the new result now shows am HIV negative. And now am so happy and free from it thanks to DR ARIBA. Please if there is any one in need of his help should kindly contact him dr.aribaspelltemple@outlook.com or call him on +2348163979933

MichelKelvin
MichelKelvin

Thanks DR ARIBA  for your kindly everybody know HIV is a deadly diseases I was once a HIV positive, Am from south Africa am 29yr I contacted this diseases when I was 23 I was using drug over since, just last week for here I see this man email on one testimony that he cure HIV so surprised when I read the testimony and I don’t believe there Is cure to HIV and I see another testimony about the same man, then I have to try I get the real true of this testimony I call the number below it and the man answer me he ask me to send down my email so we can start immediately I send the email well I don’t know how he did it but god know, He cure me less than 1hour thank you lord and Dr.ariba from healing me from this disease if you need cure 100% on HIV contact him I promise you, you we rejoice like me this is his email and number draribaspelltemple@gmail.com or dr.aribaspelltemple@outlook.com or call him +2348163979933

Jack Page
Jack Page

The emotional impact of discovering that you have HIV / AIDS can outweigh the physical health issues one has to deal with. Go to HIVMatching.com to find support and other people with HIV / AIDS in your area!