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New Guidelines Would Help Ensure HIV Treatment

International Association of Physicians in AIDS Care
International Association of Physicians in AIDS Care
Joe DeCapua

New guidelines have been released to help HIV infected people get on treatment and stay on it. The recommendations appear in the Annals of Internal Medicine. The 37 guidelines were developed by a panel of experts at the International Association of Physicians in AIDS Care or IAPAC.

“These guidelines have been somewhat long overdue. We realized that after 30 years of HIV/AIDS we still have patients with the problem of taking their tablets at a prescribed schedule, which obviously tends to make them sick, get hospitalized and die,” said Co-chair Dr. Jean Nachega, a scientist at the Johns Hopkins Bloomberg School of Public Health and a professor of medicine at South Africa’s Stellenbosch University.

Avoiding resistance

The guidelines are designed to help both the patient and the health care provider. Not taking antiretroviral drugs as prescribed can allow HIV to come back even stronger.

“The consequences are the virus keeps multiplying and the multiplication leads to drug resistance. You end up having a drug which no longer works. You need to rely on even more complex and costly drugs, which in some region of the world are not available. So it’s really problematic,” he said.

Newer antiretrovirals have made HIV/AIDS more of a chronic disease in many developed countries. Nevertheless, the Centers for Disease Control says even in the United States many people fail to take advantage of treatment. It says only 69 percent of HIV positive persons enter care and only 59 percent remain in care. What’s more, only 28 percent of Americans living with HIV have received enough treatment to have undetectable viral loads in their blood.

Recent studies have shown that treatment is also prevention.

“Someone who takes his tablets correctly is less likely to transmit the virus to his partner,” said Nachega.

Reaching out

The recommendations include intensive outreach programs to help ensure those diagnosed with HIV get into treatment programs. There would also be systematic monitoring of patients on whether they’re adhering to their treatment. Education and counseling programs are recommended so patients understand the importance of regularly scheduled doses.

The guidelines also call for screening, managing and treatment of depression and other mental illnesses, as well as pediatric and adolescent-focused therapeutic support.

"We hope to update these recommendations every two or three years obviously because as more data are found we can update our recommendations,” he said.

The International Association of Physicians in AIDS Care and the U.S. National Institutes of Health jointly sponsored the recommendations.

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