USA
Antiretroviral therapy saved three million life years
By Infectious Diseases Society of America
Jun 3, 2006 - 9:07:00 AM

On the 25th anniversary of the first reported cases of AIDS in the United States, a new article in The Journal of Infectious Diseases estimates that antiretroviral therapy has saved nearly three million years of life among people with HIV infection.

But there is still no cure. Antiretroviral therapy is the only way to extend patients' lives. Patients have the best chance of survival if they receive therapy before they develop symptoms. That makes early testing for HIV infection the key to saving lives.

"Yet one in four people living with HIV in the United States don't know they're infected. Even today, 25 years after the U.S. epidemic began, too many people aren't tested until they're already sick with AIDS," said Daniel R. Kuritzkes, MD, chair of the HIV Medicine Association.

People who test positive for HIV usually change their behavior to prevent spreading the virus. Low rates of testing are a factor in why the epidemic is still growing by an estimated 40,000 infections a year.

Part of the reason so few people are getting tested for HIV infection is because one has to ask to be tested. Furthermore, in order to be tested, the patient must receive lengthy counseling before and after the test that can take up to an hour.

"Almost no other disease requires that," added HIVMA Vice Chair Arlene Bardeguez, MD, MPH. "Imagine having to ask your doctor for a Pap smear, or to be screened for high blood pressure or diabetes, and then spending an hour on counseling. Those successful prevention efforts would reach a lot fewer patients than they do today."

The Centers for Disease Control and Prevention is developing guidelines that would make HIV testing a routine part of medical care. Patients in doctors' offices, hospitals, emergency rooms, and other medical settings would be informed that they will be tested for HIV unless they choose not to be. The sooner they become national policy, the better. Pregnant women are already being screened using this "opt-out" system, and it has reduced mother-to-child HIV transmission to near zero in this country.

However, once patients test positive, it is imperative that they be connected with care. HIV is striking most often among those who can least afford care. Implementing CDC's recommendations will identify substantial numbers of people who will need help from public programs.

All of these programs are already stretched thin. The Ryan White CARE Act is chronically under-funded and needs a major overhaul to put medical care first. Staff at Ryan White-funded institutions are already overworked and burning out. Several states have patients on waiting lists for medications or have other restrictions on care. Medicaid programs are cutting back. Medicare isn't faring much better.

Dr. Kuritzkes said, "A quarter century into the U.S. AIDS epidemic, the number of infections is still growing. We've saved three million years of life with antiretroviral therapy, and we can save many millions more--but we can't save lives until we know who needs treatment. Routine testing would identify many more people needing care. Once we have found them, the United States needs to make a commitment to provide lifesaving treatment so that no one is denied treatment simply because they can't afford it."

Dr. Bardeguez concludes, "In addition to helping those infected to live longer, we also need to help people to not get infected. Until we get effective vaccine or microbicide, we need to encourage disclosure of serostatus and decrease discrimination."

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