Marion County Public Health Department, Epidemiology Request DR2370
Prepared by: Tammie L. Nelson, MPH, CPH
The Marion County Public Health Department’s Ryan White Services Program oversees Ryan White Part A, C, and Minority AIDS Initiative grants in the Indianapolis-Carmel Metropolitan Statistical Area (MSA). These programs serve the needs of persons newly infected or living with HIV and out of care and/or uninsured or medically underserved.
New Evidence Revealed: The National Institute of Allergy and Infectious Diseases (NIAID) recently unveiled the results of a major study on early initiation of HIV antiretroviral treatment (ART).1 Begun in March 2011, the Strategic Timing of AntiRetroviral Treatment study (START)2 was conducted at 215 sites in 35 countries and enrolled 4,685 asymptomatic, ART-naïve, HIV-positive men and women with CD4+ T-cell counts greater than 500. Although START was planned to run through the end of 2016, the benefits of initiating ART, “sooner rather than later,” were so compelling that the results were released early – an action rarely seen.1
“These findings have global implications for the treatment of HIV.” – NIAID Director, Anthony S. Fauci, M.D.1
Benefits of Early ART Initiation: START findings provide solid evidence that initiation of ART prior to the decline of CD4+ T-cell count leads to significantly improved health outcomes. In fact, the study showed a 53% reduction in risk for serious illness and death. START findings also support a decrease in secondary HIV transmission resulting from decreased viral load among those for whom ART was initiated early.1
“This is an important milestone in HIV research.” – Jens Lundgren, M.D., University of Copenhagen and Co-Chair of the START study1
Guidelines: Current U.S. guidelines recommend ART for all HIV-infected individuals regardless of CD4+ T-cell count.3 In addition, the Ryan White Services Program (RWSP) strives to ensure access to ART for 100% of HIV-infected residents of the MSA. Despite these guidelines and the benefits of the RWSP, only 47.7% (N=1,846) of HIV-infected MSA residents who attended at least one HIV primary care visit during 2014 (N=3,893) had ever received ART.4
Expense, complicated regimens, side effects, social stigma, and comorbid conditions (e.g., mental health, substance use) can contribute to a reluctance to begin, or poor adherence to, ART. A summary of recent International Association of Physicians in AIDS Care suggestions may guide practitioners into increasing entry into, and retention in, ART.5 In addition, strategies to improve adherence can be found in the guidelines’ Limitations to Treatment Safety and Efficacy: Adherence to Antiretroviral Therapy.
Please keep in mind that it is important to provide your local health department and/or Indiana State Department of Health with information regarding prescription of ART (i.e., patient ID, date, medication name). If this information is not provided then an accurate estimate of the number of HIV-infected MSA residents with access to ART cannot be ascertained. Please take a few moments to report prescriptions of ART to your local health department and/or Indiana State Department of Health.
Note: Some situations may require further consideration prior to ART administration. Always consult current U.S. guidelines for more information.
1 National Institute of Allergy and Infectious Diseases: Starting antiretroviral treatment early improves outcomes for HIV-infected individuals: NIH-funded trial results likely will impact global treatment guidelines [Press release, May 27, 2015].
2 National Institute of Allergy and Infectious Diseases: NIH study examines best time for healthy HIV-infected people to begin antiretrovirals [Press release, March 7, 2011].
3 U.S. Department of Health and Human Services: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.
4 Centers for Disease Control and Prevention: Enhanced HIV/AIDS reporting system (eHARS).
5 International Association of Physicians in AIDS Care: Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: Evidence-based recommendations from an IAPAC panel.