HIV Treatment Results Are Improving — But Maybe Not as Much as We Thought

The proportion of U.S. patients who receive effective treatment has jumped from 45% in 2001 to 72% in 2010, according to a large national study, but that's still lower than some previous estimates

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Three-drug cocktail to treat HIV: retrovir (AZT), hivid (DDC) and viracept (Nelfinavir)

Nearly three quarters of U.S. HIV patients now receive antiretroviral treatment and are keeping their viral loads in check, according to a large national study released this week. The study shows dramatic improvements in therapy coverage over just the past decade — but not as large a gain as previously estimated, medical researchers say.

Researchers from the schools of medicine at the University of Pennsylvania and at Johns Hopkins University collected records from more than 32,000 HIV patients, repeatedly tested for viral load at 12 clinics across the U.S. between 2001 and 2010.

The study, published this week in the Journal of the American Medical Association (JAMA), found that 72% of HIV-infected patients in 2010 had sustained viral  suppression — that is, no sign of the virus for a full calendar year — compared with just 45% of patients in 2001. Viral suppression is very important, both because HIV viral load is linked to symptom progression among patients, and also because it’s a marker of patients’ infectiousness. People with HIV who receive effective treatment not only have lower risk of progressing to full-blown AIDS; they are also much less likely to spread the virus than are patients with insufficient treatment.

However, that 72% figure — the proportion receiving treatment and controlling their viral load — is still lower than some previous recent estimates, according to the authors of the new study. While previous research has found successful viral suppression among a larger proportion of HIV-infected people, some 77% to 87%, those studies had used a more lenient definition of viral suppression. It was often based on just one measurement value, rather than a longstanding record of viral-load measurements, as used in the current study.

There may be many reasons for the improvement over time in treatment results. The study authors say that new drugs and fixed-dose tablets in the past decade have made antiretroviral therapy more effective, and with fewer side effects. That helps patients stick to their drug regimens, and keep viral loads in check. The authors say that better access to care may also contribute to better outcomes.

But not all patients have benefited equally. The JAMA study found that older patients and people with private health insurance were most likely to have sustained viral suppression, while African Americans, injection drug users and people without private insurance were less likely.

“There is no denying the progress we have made over the past decade,” lead study author Baligh Yehia told reporters. “But more resources and new technology are needed to ensure that more patients have access to HIV therapy and obtain the full benefits of these drugs,” he said.