A Major Breakthrough In Treatment Of HIV/AIDS

(This image is from medicalnewstoday.com.)

We don't hear a lot about HIV/AIDS in the news these days, but it still affects millions of people -- both in this country and the world. That's why it is great news that a major medical breakthrough has been found to fight the disease. It doesn't involve a new medication, but on when the current medications should be started. Here is how that breakthrough is described by Tara Culp-Ressler for Think Progress:

A major international clinical trial funded by the National Institutes for Health (NIH) has been cut short a year early, now that researchers have documented such compelling results about the right way to deliver HIV treatment.

The Strategic Timing of AntiRetroviral Treatment (START) study, which has been tracking more than 4,600 HIV-positive people in dozens of countries since 2011, aimed to figure out when patients should begin taking a combination of drugs that can effectively suppress the virus. 

Antiretroviral drugs are a major advance in HIV treatment that allow many HIV-positive individuals to live long and healthy lives. But, since the drugs can also come with significant side effects, global health experts have been hesitant to recommendprescribing them too early. The START study wanted to see whether it was better to start anti-retroviral therapy immediately, when HIV patients are still relatively healthy, or wait until their white blood cell count drops below a certain point. 

The clinical trial, which was initially scheduled to conclude at the end of 2016, randomly assigned participants to early and later treatment groups. But it became clear that the first group was delivering dramatically better results. Among the HIV-positive people who received early treatment, the risk of dying or developing a serious illness was reduced by 53 percent. 

The researchers considered those results to be so significant that they decided it wouldn’t be ethical to continue the study for another year. Instead, they’re halting it now and giving all of the participants immediate access to antiretroviral drugs.

“We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later,” Dr. Anthony Fauci, the director of NIH’s National Institute of Allergy and Infectious Diseases, which funded most of the research, told NBC News. “These findings have global implications for the treatment of HIV.”

Indeed, the NIH’s results may have a demonstrable impact on the estimated 35 million people living with the virus. Although the World Health Organization has recently updated its treatment guidelines to recommend starting antiretroviral treatment early, it still stipulates that patients’ white blood cell count should fall below a certain threshold before taking the drugs. START’s results could spur the international community to endorse treatment for everyone diagnosed with the virus — the position that the United Nations’ AIDS agency took after the study’s findings were publicized.

“Every person living with HIV should have immediate access to life-saving antiretroviral therapy,” Michel Sidibé, the executive director of UNAIDS, said in a statement. “Delaying access to HIV treatment under any pretext is denying the right to health.”

The results aren’t necessarily a surprise to researchers in the field, who have increasingly been documenting the benefits of early HIV treatment. But they provide the most compelling evidence so far that the potential side effects of the drugs are not serious enough — and the benefits to patients’ personal health are too great — to justify delaying treatment, even for people who still appear to be healthy. Dr. Jens Lundgren of the University of Copenhagen, who helped sponsor the START study, called it “an important milestone in HIV research.”

Not every country, of course, will be able to immediately begin providing this treatment to everyone with HIV. The global health community is continuing to work toward universal access to HIV treatment, but we’re not there yet. Although the price of antiretroviral drugs has recently dropped thanks to increased competition in the market, cost issues remain a concern.

The study results also underscore the importance of regular testing and early diagnosis, something that HIV prevention experts have been saying for years. 

Although routine HIV testing is now covered under Obamacare as an essential preventative health measure, there’s a long way to go here in the United States, where about 15 percent of HIV-positive Americans don’t know they have the virus. That number rises dramatically among young Americans between 16 and 24 years old, 60 percent of whom are unaware of their status. This particular knowledge gap contributes to the fact that — despite the advances in HIV treatment that ensure a diagnosis is not a death sentence — federal officials report just three in ten Americans living with HIV currently have the virus in check.

HIV Entry Ban Is To Be Lifted

In 1987, in the midst of the HIV-AIDS panic here in the United States, the government added being HIV-positive to the list of diseases that would bar emigres or visitors from entering this country. For the last 22 years that has been the law.

But for most of that 22 years, it has been known that HIV-positive persons really did not pose a risk to the population in general. Long ago, most civilized nations realized this and did away with any bans (if they had imposed one), but the United States and perhaps a dozen other countries have kept the ban in effect. Thankfully, that is about to change.

Yesterday, President Obama signed a bipartisan extension of the Ryan White HIV/AIDS Treatment Act, which provides health care treatment and support for about 500,000 HIV/AIDS patients. At the same time, the president announced he would be lifting the HIV-positive ban for emigres and visitors because it was "rooted in fear rather than fact".

He went on to say, "We lead the world when it comes to helping stem the AIDS pandemic -- yet we are one of only a dozen countries that still bar people with HIV from entering our own country. On Monday, my administration will publish a final rule that eliminates the travel ban effective just after the New Year."

We used to lead in world in the establishment and teaching of human rights issues, but this time we are a very tardy follower. Sadly, that is happening far too often.

U.S. To Change HIV Visa Policy

There are a handful of rather backward thinking countries that discriminate against people with the HIV virus -- countries like China, Yemen, Iraq and Sudan. But among the civilized and industrialized Western nations, there is only one -- the United States. Most of its citizens probably don't know it, but the U.S. still refuses to grant an entrance Visa to anyone known to have the HIV virus.

The reason is that the government still lists having the HIV virus as a "communicable disease of public health significance". That rating means an automatic denial to anyone applying for a Visa. The law was designed to protect the American population from truly communicable diseases that are spread by contact or through the air. But haven't we known for years now that HIV does not have that kind of communicability?

The U.S. policy was highlighted last month, when HIV and TB activist Paul Thorn was refused admission to the United States. Thorn was supposed to speak at a health summit in Seattle. He had entered the U.S. several times before by lying on the Visa application, but said he was tired of lying.

According to Thorn, "The US government gives people who have HIV one of two choices. The first is to actually be dishonest on the visa application or visa-waiver form, commit a felony by lying to US immigration, and become a criminal. The second choice is to be honest, and have a visa rejected because you are considered an undesirable person, and unfit to enter the US. To my mind either being a criminal or an undesirable isn't much of a choice. I don't want to be either."

After being denied entrance to the U.S., Thorn sent a statement which was read to the summit. The statement blasted the United States policy. Evidently, the government was embarrassed by the statement, because Thorn has been notified that the policy will be changed.

I'm glad the U.S. is finally changing this law. But I have to wonder why it was still in effect. Must the United States always be embarrassed before getting rid of ridiculous and outdated laws?