When people test positive with HIV, the decision on when to start medications is essentially up to them, but the current U.S. guidelines call for different approaches, depending on the body’s level of CD4 — a form of white blood cells crucial to the immune system also known as T-cells. The normal range in healthly people is between 500 to 1800 CD4 cells per cubic millimeter of blood; a diagnosis of AIDS means the CD4 level is lower than 200.
In general, patients with symptoms of HIV disease or with CD4 levels below 350 have been told they should definitely begin treatment, while treatment is “recommended” for patients with CD4 counts under 500.
But this leaves the question: Why wait to start treatment? Would we tell people with diabetes to wait until their disease progressed to begin treatment? Why not treat them when the person is already healthy?
It’s also important to note that getting your virus under control means you are healthier and less infectious because the amount of the virus that is detected theoretically will be very low if you are on your medications and taking them every day. And this is important, especially in Black and Latinos communities where HIV rates are statistically higher.
Well, New York City health officials are saying no more waiting: People who have been diagnosed with HIV should start treatment immediately, regardless of how healthy or high your CD4 counts are.
But there are some serious questions about recommending treatment or making it optional that need to be addressed moving forward. Because essentially it’s up the person as to when they start their treatment. Not to mention the unknown impact that taking these medications can have on the liver, kidneys and heart.
HIV experts are split about whether early therapy should be recommended or optional. Besides the high costs, the pills have side effects from nausea to liver damage. Patients unwilling to take them religiously for life could develop drug resistance.
A panel that recently updated U.S. guidelines was divided evenly, with half favoring starting therapy early for everyone and half regarding an early start as elective.
But there's growing evidence that untreated HIV can lead to cancers and heart disease. What's more, antiretroviral drugs are safer, have fewer side effects and work better than they did in the past. New research also indicates that people live better, healthier lives and their partners do as well when they get early treatment.
The new research cited by [New York City’s] Health Department in making its recommendations includes a nine-nation study whose preliminary results were announced earlier this year and showed that earlier treatment meant patients were 96 percent less likely to spread the virus to their uninfected partners.
Currently in New York City, more than 110,000 people are living with HIV — the most of any city in the United States. According to the New York City HIV/AIDS Annual Surveillance Statistics for 2009, of the 3,669 new cases of HIV, 1761 — almost 50 percent — occurred among Black New Yorkers.
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