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All HIV Patients Should Take Meds Early On, Experts Now Say

New guidelines reflect the improvements in antiretroviral therapy over last 25 years

MONDAY, July 23, 2012 (HealthDay News) -- A new report recommends that physicians begin treating all HIV-positive adults with antiretroviral drugs instead of waiting, at least in countries where the therapy is easily accessible.

All HIV-positive patients should take the drugs, even if blood tests reveal that their immune system is healthy, according to the revised guidelines, which were presented Sunday at the International AIDS Conference in Washington D.C., and published in the July 25 issue of the Journal of the American Medical Association.

Over the last 25 years, antiretroviral drugs have become stronger, easier to tolerate and simpler to take, the authors of the report explained. "New trial data and drug regimens that have become available in the last two years warrant an update to guidelines for antiretroviral therapy in HIV-infected adults in resource-rich settings," Dr. Melanie Thompson and her 2012 International Antiviral Society-USA Panel colleagues said in the report.

While medications don't rid the body of HIV -- the virus that causes AIDS -- they can prevent the virus from replicating and have allowed millions of people to live for years with a greatly reduced threat of developing AIDS, experts have noted.

However, not every person infected with HIV takes the medications. In some cases, doctors prefer to wait until a patient's immune system begins to show signs that the virus is becoming stronger.

The reasons why doctors sometimes wait to prescribe antiretroviral medications may be because the drugs can cause side effects, and there's also the challenge that patients must keep taking them or take the risk that the virus will rebound.

Commenting on the report, Rowena Johnston, director of research with the Foundation for AIDS Research in New York City, explained, "We can't lose sight of the fact that this is a big commitment. Once you start, you can't stop."

The report recommends that initial treatment include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine [brand name Truvada] or abacavir/lamivudine [known as ABC/3TC]) plus a non-nucleoside reverse transcriptase inhibitor (efavirenz [Sustiva]), a ritonavir-boosted protease inhibitor (atazanavir [Reyataz] or darunavir [Prezista], or an integrase strand transfer inhibitor (raltegravir [Isentress]).

The new guidelines are a sign of a "turning point" for HIV drugs, Johnston said. These medications are now being considered not only as a treatment but as a prevention tool because those who take them are less likely to infect other people, she noted. "The scientific community really recognizes how valuable they could be to prevent transmission," she said.

There are challenges, though, Johnston pointed out. One obstacle is money to pay for the drugs, even in rich countries such as the United States. There's also the matter of getting people to be tested in the first place and then to seek and retain medical care if they learn they are HIV-positive, she said.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about HIV and AIDS.

SOURCES: Rowena Johnston, Ph.D., director, research, Foundation for AIDS Research, New York City; July 25, 2012, Journal of the American Medical Association
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