Special Considerations in HIV Management - Episode 22
William Short, MD, MPH, AAHIVS: I think what’s changed, and it’s really been sort of the standard of care now for a couple of years, is that when patients are diagnosed, you want to get them on treatment right away. You really want to get their viral loads controlled. And that really comes from a lot of data that we have now. I think the biggest data is, first and foremost, that it decreases morbidity and mortality. We know that.
But there was always a question if someone had a CD4 count more than 500—so they were the so-called healthy patient—what benefit did antiretrovirals give to them? And there was a really large trial called the START study. It basically randomized patients to start antiretrovirals when their CD4 count was greater than 500 or wait until they fell below 500. And that trial was stopped in 2015. There were 2 composite endpoints. It was time to AIDS event or non-AIDS event. And a lot of those non-AIDS events were malignancies, and the AIDS events we think about are things like tuberculosis, Kaposi sarcoma. And really what we saw is a dramatic decline in both of those endpoints. So we really did stop, and that became the standard of care. So, again, for a lot of us, we’re seeing patients and we really are moving to get them diagnosed, get them into care, get them started on therapy. Really getting them controlled pretty rapidly.
One of the other benefits that I think is most significant, and it’s really important for patients, is getting them on medication, or antiretrovirals, getting them undetectable, keeping them undetectable, and then really being able to share with them that their ability to transmit the virus to an uninfected partner is almost zero0. And, again, we talked about this earlier, the U=U campaign. The undetectables, untransmissables. And I think that’s an important message for providers to know, providers who are unfamiliar with the HIV treatment landscape or paradigms that have changed.
The other piece is, and it’s very important, is that the CDC has actually came out and endorsed this campaign as well. So, again, another benefit at really getting those patients diagnosed, into care, get them on treatment right away.