Backlash Vanquished in Massachusetts

VOLUME 3, ISSUE 344 | November 4 – November11, 2004

HEALTH

New HIV Drug Guidelines

Eight years after regimens launched, ‘hit early, hit hard’ is updated

The U.S. Department of Health and Human Services has issued new guidelines on when a person who is infected with HIV should begin taking anti-viral drugs.

The guidelines, which were issued on October 29 and are available at http://aidsinfo.nih.gov, recommend that people who have not previously used anti-HIV drugs who have a viral load over 100,000 should consider starting AIDS drugs, even if their T cell count exceeds 350.

A T cell count is a measure of a type of immune system cell that is attacked by HIV. The lower the count, the more compromised the immune system. Viral load is a measure of the amount of virus in a person’s body. A higher viral load means more virus is present.

Gregg Gonsalves, director of treatment and prevention advocacy at Gay Men’s Health Crisis (GMHC), who sat on the federal panel that drafted the new guidelines, said they would be useful for patients and doctors.

“We believe that patients should be managing their education with their doctors,” he said.

“The treatment guidelines aren’t just for doctors. Treatment is to be co-managed with people who are taking the drugs.”

The guidelines recommend that people who have a T cell count below 200 or are experiencing AIDS-related symptoms begin treatment, regardless of their viral load.

“That is unanimous,” Gonsalves said. “I don’t think anybody should question that.”

In 1996, powerful anti-HIV drugs, known collectively as highly active anti-retroviral therapy, or HAART, came on the market. The prevailing treatment practice then was “hit early, hit hard” with the view that starting treatment as soon as an HIV diagnosis was made might eliminate the virus from a patient’s body. That has not proven true.

“People have beaten a retreat from that and there is a much more conservative view, conservative in a good way, about when to start treatment,” Gonsalves said. “They used to say that if people go above 55,000 viral load they should start treatment. Now, the bar for starting is a little higher. It is moving further away from hit early, hit hard.”

The drugs are expensive, some have very unpleasant side effects, and the virus can develop resistance to the drugs over time rendering them ineffective.

“Use the drugs when you need them,” Gonsalves said. “It’s not like there is an unlimited supply of regimens people can take.”

The new guidelines also have recommendations about which drugs to use first and how to treat special populations, such as adolescents, injecting drug users and people with other infections such as hepatitis B and C or tuberculosis. These special populations may need additional help in complying with the sometimes-complicated treatment regimens. Doctors and patients may need to consider interactions among anti-HIV drugs and other drugs, both legal and illegal, that patients may be taking.

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