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Study: For HIV Patients, Early Diagnosis Doesn’t Always Mean Early Treatment

February 3, 2014

When it comes to HIV, treatment is prevention. If an HIV-positive individual can stick to a regimen of HIV drugs and achieve lower levels of the virus in their body – a state known as viral suppression – they have up to a 96-percent reduced risk of passing the virus to someone else.

In 2012, national HIV guidelines were revised to recommend that patients begin treatment, called antiretroviral therapy (ART), as soon as they test positive, rather than waiting until the disease progresses to a more advanced stage.

But according to a new analysis by scientists at the Georgia Department of Public Health (DPH), patients in the earliest stages of the disease are less likely to achieve viral suppression than those in the later stages of the disease, likely indicating the lack of treatment or adherence to taking medication. The report was published by the Centers for Disease Control and Prevention (CDC) in the Morbidity and Mortality Weekly Report (MMWR) on Friday.

This is the first time scientists have studied whether HIV disease stage -- stage 1 is the earliest, stage 3 is the most advanced -- at diagnosis can determine if a patient will achieve viral suppression. The authors said the findings can guide efforts to identify patients with HIV, link them to medical care and help them stay in care – what health professionals call the HIV care continuum.

“This article not only provides an opportunity for national recognition of DPH epidemiologic work, but also offers a scientific basis to inform public health and clinical practice in regards to initiation of antiretroviral therapy among persons with stage 1 disease at the time of HIV diagnosis,” said Cherie Drenzek, D.V.M., state epidemiologist at DPH and one of the study’s authors.

The earlier a person with HIV can start taking medication, the better. If a patient with HIV is diagnosed while still in stage 1, the more time health professionals have to link them into care and to the ART drugs they need to lower the virus levels in their bodies. This viral suppression not only improves the health of the patient but also protects the community by reducing HIV transmission. But the DPH study found that even among patients who stay in treatment, those who are diagnosed in the earlier stages of the disease (stage 1 and 2) often have less viral suppression than patients in stage 3.

According to the report, 958 of the 1,340 HIV-positive patients in care in Georgia achieved viral suppression. Viral suppression was achieved in 64.5 percent of the patients who were diagnosed in stage 1, 72.3 percent in stage 2 and 80.5 percent in stage 3.

“More emphasis needs to be put on educating patients about the importance of initiating ART in early disease stages to benefit themselves and the community,” said Laura Edison, D.V.M., the study’s lead author. “Early diagnosis allows for timely interventions, but the benefit is lost if ART is not initiated.”

Edison also said the findings emphasize the importance of the new national guidelines encouraging doctors to begin treating patients in the earliest stages of HIV.

“Many physicians still do not do this because these guideline changes are relatively new and some physicians have not adopted them yet,” she said.

The study’s authors also hope that the findings can be used in the future to help researchers determine how the new guidelines impacted care for patients and levels of HIV in the community.

To read the article, visit the MMWR online.