An Interview With Joel Gallant, M.D., M.P.H., and Paul Sax, M.D.
Myles Helfand: All right. Do either of you have any closing thoughts? Anything on the when-to-start question that we haven't touched on, or that you'd like to say before we close up? Dr. Sax?
Paul Sax: I think it's important to continue to have these dialogues about this issue. I know that I've heard from some of my European colleagues that they don't find the data as compelling as we do. If we keep an open mind, we're more likely to learn. So even though Joel and I are in agreement on this, I have to allow that this [starting HIV treatment early] is not one of those obvious situations, like it is when you're treating people with more advanced immunodeficiency.
Joel Gallant: Yeah. I think the Europeans, and the British physicians and guidelines panelists, very much have to weigh cost in their decisions. In systems where there's a fixed pot of money and they have to decide the greatest good for the greatest number, it's impossible to ignore cost.
In the U.S., we've had the luxury of not having to think too much about that. We've been able to be purists, and just talk about what we think the scientific data show, in terms of our recommendations. Maybe we've been deceiving ourselves that way.
But my own opinion is that, when you consider both the treatment and the prevention aspects and benefits of antiretroviral therapy, we can't afford not to treat people. And I do think we have the money to do it.
Paul Sax: Exactly. The problems with the U.S. health care system are so huge that I don't even want to start. But the reasons why it's so expensive do not have to do with antiretroviral therapy. I think that's pretty much all I need to say.
Joel Gallant: Absolutely. I mean, antiretroviral therapy may be pricey, but it has been shown to be one of the most cost-effective medical interventions that we have. And that's without the prevention benefit; that's just looking at treatment. If you add in the prevention benefit, it just seems overwhelming.
Myles Helfand: On that sobering but slightly optimistic note, we'll wrap up. Thank you, Dr. Gallant and Dr. Sax, for taking part in this discussion.
This transcript has been edited for clarity.
Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.
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