Public Health

San Fran Pushes For Earlier HIV Treatment

San Francisco's Department of Public health is expected to announce some big changes in the city's HIV/AIDS treatment policy next week. HIV-positive patients will be advised to begin antiretroviral (ARV) therapy as a preventative step, well before their immune systems show significant signs of faltering, according to the New York Times.

"We've learned that for people in the earlier stages of HIV, the virus is [already] enacting damage to the organs," Dr. Diane Havlir, director of the UCSF HIV/AIDS Division at San Francisco General Hospital, told Shots. "Starting therapy earlier could help prevent cascading events."

Antiretroviral therapy is traditionally used to stall or prevent the progression of HIV to AIDS, and it can also prevent other side-effects of a degenerating immune system, like opportunistic infections and cancers. But, those medications can also prevent liver, kidney and heart disease related to ongoing HIV replication, and possibly even cognitive deterioration, Havlir said. And some recent studies support this: at least one study found that early initiation of ARV treatment improved survival rates.

Patients at San Francisco General are already being advised to start ARV medications early on. But right now, the national guidelines for initiating antiretroviral therapy — which came out last December — only recommend early treatment for patients with low CD4 cell counts, as well as pregnant women and other at-risk groups.

San Francisco's plan comes amidst huge budget shortfalls in California and around the country, which have hit HIV/AIDS funds hard. In fact, California's Office of AIDS has been facing major funding cuts over the past years.

The New York Times reports that the plan for an expanded ARV program in San Francisco is unfurling without a clear picture of its cost to city and state health agencies, but Havlir told Shots "the goal of this is to keep people from getting sick, which of course results in cost savings." Dr. Mitch Katz, director of San Francisco's Department of Public Health was unavailable for comment at the time of this post.

A secondary benefit of the push for earlier ARV treatment could be a lower HIV transmission rate at the community level; antiretrovirals help lower the amount of virus circulating in the body. And there is some data to support this idea.

"The city of San Francisco has a very sophisticated monitoring system for viral load and new infections that will be able to observe what happens with this change of policy," Havlir said. But, she added, "our clinic policy is being implemented for the benefit of individual patients. The secondary effect of curbing transmission is just that, a secondary effect."



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