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SF to Announce New HIV Guidelines


San Francisco public health officials next week will announce aggressive new guidelines that call for people with HIV to begin taking antiviral medicines as soon as they learn they are infected. The controversial new policy departs from previous guidelines that called for HIV patients to take the medications only when signs showed their immune systems had begun to fail.

According to The New York Times, "Behind the policy switch is mounting evidence that patients who start early are more likely to live longer, and less likely to suffer a variety of ailments -- including heart disease, kidney failure and cancer -- that plague long-term survivors. Studies suggest that in the early years of infection, when a patient may show few signs of immune system failure, the virus is in fact causing permanent damage that becomes evident later.

"The turning point in San Francisco's thinking may have been a study in The New England Journal of Medicine on April 1, 2009, that compared death rates among thousands of North American HIV patients. Dr. Mari Kitahata, an epidemiologist at the University of Washington, and her team of researchers found that patients who put off therapy until their immune system showed signs of damage had a nearly twofold greater risk of dying -- from any cause -- than those who started treatment when their T-cell counts were above 500."

Proponents of early treatment also say it has the potential to slow the spread of HIV by reducing the level of virus among the population. Opponents argue that the therapy remains costly, and that the effects of taking the drugs long term remain unknown. Results from a University of Minnesota study on that question are not expected until 2015, according to the Times.

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Julie Bolcer