The Conference on AIDS in Chicago

The Conference on AIDS in Chicago

Antiretroviral Therapy Discussion

The plenary session featured a discussion of the HIV prevention benefits of antiretroviral therapy (ART) -  also known as combination therapy which involves using a combination of three or more antiretroviral (ARV) drugs from at least two different HIV drug classes to prevent HIV from replicating (read more about ART on NIH’s AIDSinfo site). Dr. Tony Mills, a UCLA HIV physician, discussed new evidence suggesting the potential for ARVs to serve two important new roles in the fight against HIV, in addition to their original function of prolonging health and improving survival among persons living with HIV. These included: 1) reducing the risk of HIV transmission by lowering the infected partner’s viral load with early treatment initiation (known as “treatment as prevention”); and, 2) decreasing the risk of HIV acquisition through pre-exposure prophylaxis (PrEP).  Dr. Mills reviewed the implications of HPTN 052, which offers the most definitive evidence that early treatment initiation curbs the risk of HIV transmission in stable, discordant heterosexual couples. He also examined the potential of PrEP for averting new infections, stressing that the research (see posts about the iPrex study) indicates that the level of protection was dependent on adherence to the treatment regimen. He also noted that currently the evidence base for the use of this prevention intervention exists only for men who have sex with men, but that additional studies are underway testing its effectiveness with other populations. He highlighted CDC’s interim guidance on the use of PrEP in men who have sex with men and raised some of the questions the HIV community is facing regarding deploying this intervention such as how will it be administered and by whom? 

Increasing Routine HIV Testing in Primary Care

According to the CDC an estimated 20 percent of people with HIV in the United States do not know their status. Studies show that most persons who are aware of their HIV positive serostatus take steps to reduce transmission risks. Research also shows that many persons with undiagnosed HIV infection regularly access health care services but many opportunities are missed to diagnose and link them to sustained, health preserving treatment and care. In a session yesterday, representatives of Urban Health Plan, Inc. Exit Disclaimer, a New York City-based multi-site federally qualified health center, shared results and lessons from their effort to implement routine HIV testing in a primary care program. Workshop participants acknowledged several challenges to implementing routine testing in primary care settings, including administrative barriers, provider buy-in, patient flow, staff turnover, documentation, and test costs.