The Sydney Mardi Gras festival has commenced with a beautiful Fair Day on Sunday. As I wandered around amongst the crowds of happy fair goers, weaved past gorgeous dogs and people of all hues, I reflected on what a fantastic space we have come to in our communities. A place where HIV-positive and negative people can safely travel together, where relationships are not so fraught with the uncertainty of HIV whether HIV will be transmitted between sexual partners infection, and where for poz people there is no longer an inevitable decline into ill health because of HIV.
The jury is in: earlier treatment nails HIV and many of its effects
All of this is, in large measure, due to the benefits brought about by treating HIV as soon as possible after diagnosis. This blog has reviewed the compelling and irrefutable evidence from the START Study (the largest study ever to specifically investigate the best time to start treatment) that starting treatment early boosts immune recovery and reduces the risk of serious disease even in people with CD4 counts (how much HIV is present in the blood) above 500. Much less is heard about the TEMPRANO Study in West Africa which had similar findings to START, that those who start treatment early reduce their risk of serious illness (including cardiovascular illness and cancer).
The guidelines reflect the good news
The US treatment guidelines for adults and adolescents with HIV (which Australia follows in virtually all areas of HIV care) were revised three weeks ago. They argue that earlier treatment increases the probability of restoring normal CD4 counts, maintaining a normal CD4/CD8 ratio, reducing inflammation and damping down the damaging activity of the immune system as it attempts to control HIV: all good news.
What about special cases …
There are some people whose immune systems are built so that can maintain very low HIV viral loads and maintain CD4 counts for many years. The revised guidelines strongly discourage waiting to see whether this is the case: they recommend early treatment for everyone, regardless of viral load and CD4 count. Even such fortunate individuals with normal CD4 counts nevertheless have levels of activated immune systems with increased risk of cardiovascular and other serious illness, and ongoing damage continues in their immune systems: all of that is reduced by early treatment.
There is so much good news for people with HIV: treatments have less side effects, are more convenient and more effective. Treatment brings life-long benefits for good health and reduces risk of passing on HIV… what more could you ask?