Guidelines focus on newly diagnosed HIV patients

Worried that too few people with HIV receive the care they need, infectious diseases experts have issued guidelines calling on physicians to ensure that newly diagnosed patients start treatment and adhere to life-long drug regimens.

The recommendations were developed by a panel of 31 HIV experts on behalf of the International Assn. of Physicians in AIDS Care. They were published online March 5 in Annals of Internal Medicine.

The guidelines urge health professionals to monitor the entry of patients they diagnose with HIV into treatment programs. After the initial visit for such programs, nurses or other staff members periodically should call patients to ensure that they are properly taking their medications.

Adherence also can be monitored through systems that alert physicians when a patient does not pick up his or her prescriptions, said Larry W. Chang, MD, MPH, co-author of the guidelines and an assistant professor of Medicine at Johns Hopkins University School of Medicine in Baltimore.

Primary care physicians who refer patients to an HIV/AIDS specialist should follow up with the patient to confirm that he or she is keeping appointments, Dr. Chang said.

The recommendations are based on the findings of 325 studies, which involved tens of thousands of people infected with HIV around the world (link). They come as primary care physicians increasingly are caring for people with HIV, due in part to effective treatments that have enabled patients with the disease to live long enough to develop chronic health conditions that are common in primary care, HIV experts say.

“These guidelines will provide primary care physicians with some guidance on tools they can use to provide support to their patients with HIV” and monitor their medication adherence, Dr. Chang said.

An estimated 1.2 million Americans live with HIV, and 20% of them do not know they are infected, according to the Centers for Disease Control and Prevention.

Too few people continue treatment

Standard antiretroviral therapy consists of using at least three drugs to maximally suppress the HIV virus and stop the progression of the disease, according to the World Health Organization. Properly taking the medication can enable patients to live to old age and dramatically decrease the risk of transmitting the infection through sexual activity, infectious diseases experts say.

But the CDC estimates that only 28% of people with HIV in the U.S. have a suppressed viral load. Part of the problem is that too few people (69% of those diagnosed with HIV) have started medical care, and only 59% continue therapy, the guideline authors say.

“Missed doses and drug holidays lead to resistant virus and often to treatment failure,” said Melanie A. Thompson, MD, co-chair of the panel that developed the guidelines. “Individual and public health depend on helping patients” stay in treatment and properly take their medication. Dr. Thompson also is founder and principal investigator of the nonprofit AIDS Research Consortium of Atlanta.