July 12, 2009

July 12, 2009

Early Treatment for HIV Act (ETHA)

Earlier Treatment for a Longer Life?

Thanks for joining me on my relaxing Sunday at home while I am still recuperating from lower back problems. I hope you are having a safe and great weekend.

Today I would like to talk about early treatment for people with HIV.

The Early Treatment for HIV Act (ETHA) is proposed legislation that, if passed, will provide states the option of expanding Medicaid coverage to individuals living with HIV.

The proposed legislation is modeled after the Breast and Cervical Cancer Prevention Treatment (BCCPT) Act of 2000, which amended Title XIX of the Social Security Act giving states the option of expanding Medicaid coverage to women who were found, through early intervention programs, to have breast or cervical cancer. In a similar manner, ETHA would provide resources to pay for early intervention, treatment and health care for people living with HIV.

Currently, most individuals with HIV/AIDS who qualify for Medicaid do so because they are certified as disabled. Usually, this certification comes after an individual has received an AIDS diagnosis. This means that many of these people are too sick to benefit from current therapies by the time they qualify for Medicaid. Successful passage of ETHA would allow more HIV positive people to receive treatment at earlier stages of the infection.

It might be hard to believe, but in the United States 40% of people who are newly diagnosed with HIV advance to an AIDS-defining condition within one year. This highlights the dire problem that people are testing very late in their disease progression and are only able to start on medications when their T-cells are low.

In fact, the average T-cell count of Americans newly diagnosed with HIV is only 187. Remember that a T-cell count of less than 200 is an AIDS-defining condition, but more important, it also increases a person's likelihood of developing certain opportunistic infections. Clearly, health care reform needs to address this issue making HIV testing routine for everyone.

But new data from clinical trials have begun to hint that starting anti-HIV meds when T-cells counts are higher (greater than 500) than current recommendations could be beneficial and could prevent many of the complications of untreated HIV.

The reasons for starting meds early include preventing not just diseases related to HIV but non-AIDS related complications like heart disease, kidney damage, neuropathy and anemia. One HIV outpatient study being done at the National Institute of Health has shown that the rates of these complications were much higher when patients started on anti-HIV medications when their T-cells count were lower than 200, compared to those who started when their counts were greater than 200.

Current guidelines recommend starting HIV-positive people on medications when their T-cell count drops below 350. Newer data, reported at this year's Conference on Retroviruses and Opportunistic Infections, suggest that treatment should be started when the count is great than 500. Why so high? When investigators looked at 22 different trials of approximately 9,000 patients they found that the ones who started meds when their counts were less than 500 had a grea than 90% increased risk of death! And the majority of these deaths were due to non-AIDS related conditions, like heart disease or cancer as well as liver and kidney failure.

Although starting treatment so early may prevent a lot of damage that HIV does, the risk of someone getting very sick if he or she waits to start when Tcells drop to just below 350 is quite small. Further, once you commit to starting on therapy, there may be issues with adherence and toxicities to the medications. Fortunately, current regimens are more convenient and are well tolerated.

The decision of when to start on anti-HIV medications is a very important one. But with newer studies suggesting that untreated HIV causes a lot of inflammation and that may contribute to heart and kidney disease as well as to increased rates of cancer, starting HIV therapy at a higher T-cell count could very well prevent some of these complications.

So contact your elected representatives about passing the Early Treatment for HIV Act today.

Hope you have a great week. Wishing you health, hope and happiness.

big bear hug,

Daddy Dab