May 7, 2010

May 7, 2010
Waiting Too Long?

Welcome to another day in my life. Today is Friday and we have almost made it through another work week. I hope you have had a safe and great week so far.

It is another typical weather day here in south Florida which mainly means it is hot and humid with the occasional thunderstorm to help cool things off. I know people down here are keeping a weary eye on the major oil leakage in the Gulf of Mexico since there have been some warnings the Gulf current could send the oily mess our way.

One of the things my close friends know about me is I hate to be late for anything. This is mainly because I believe it is rude to show up late unless it is a casual drop in type of event. If I make an appointment with someone, I believe I should be on time so I do not waste their time.

Another thing that bothers me is a recent study which shows a majority of people have still not been tested for HIV. Not only does this surprise me but it also pisses me off to a certain extent. I personally feel it is an individual responsibility to know whether you are passing on STDs if you have multiple sexual partners. Am I wrong?

A new study shows that a disproportionate number of people living with HIV notably women, African Americans and older adults are presenting for care with low CD4 counts, a troubling concern that has not improved significantly in recent years. The results were published in the June 1 issue of Clinical Infectious Diseases.

Waiting to start antiretroviral therapy until CD4 counts are well below HIV treatment guidelines leads to numerous problems. Not only does this increase the risk that a person will develop an AIDS related opportunistic infection, but it may also increase his or her risk of developing cardiovascular disease and certain cancers. What is more, when people wait too long to start ARV treatment, the chances of achieving and maintaining a healthy CD4 cell count are reduced. A number of studies have found that a significant number of people who present late to HIV care did so because they hadn’t been tested for the virus and did not know their status.

To assess when people are entering HIV care, and how this trend has changed over time, Keri Althoff, PhD, MPH, from Johns Hopkins University in Baltimore, and her colleagues analyzed data from a large HIV cohort study called the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Althoff’s team examined data on 44,491 people with HIV who presented for HIV care for the first time between January 1997 and December 2007.

Althoff and her colleagues found that the average CD4 count upon entering care increased between 1997 and 2007, but only slightly from 256 to 317. More than half the people in the study, however, should already have been on ARV treatment upon entering care using the minimum guidelines now in place in most developed nations, which is a CD4 count less than 350. Althoff’s team found that 54 percent of those who first presented for care in 2007 already had a CD4 count that had fallen below 350, compared with 62 percent in 1997.

The greatest gains in getting people into care earlier, according to the study, were seen among Latinos, men who have sex with men, and injection drug users. Heterosexuals, African Americans and older individuals lagged behind.

“These data provide strong evidence that implementation of new strategies for earlier testing and effective linkage into care are urgently needed,” write the study’s authors.

In an accompanying editorial, Cynthia Gay, MD, MPH, an assistant professor of medicine at the University of North Carolina at Chapel Hill, concurs. “Earlier in the epidemic, many predicted that improvements in HIV therapy and outcomes would translate into increased HIV testing, and thus earlier diagnosis and care. The work of [Althoff’s team] and others refutes this,” Gay asserts. “We have to ask why we fail to help more HIV infected individuals access treatment earlier in their disease course.”

So please if not have not been tested do so. It is much better to know than to be burying your head in the sand. Not to mention the fact you could be passing on things to others. If you do not care about yourself, at least care about other people.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab