Study Finds Test-and-Treat Strategy Could Lead to More Drug Resistant HIV Cases

March 25, 2013

Study Finds Test-and-Treat Strategy Could Lead to More Drug Resistant HIV Cases

Read more about early HIV treatment strategies here.

In the United States, Los Angeles County has the largest incident population of HIV-positive individuals and now ScienceDaily reports that a new study from the University of Southern California (USC) Schaeffer Center for Health Policy and Economics and the RAND Corporation has found that "One of the most widely advocated strategies for dealing with HIV/AIDS could double the number of multi-drug-resistant HIV cases in the population of men who have sex with men (MSM) in LA County over the next 10 years." Advance online publication of the study is available in Clinical Infectious Diseases.

The so-called "test and treat" policy -- which calls for universal testing for HIV, as well as treatment with antiretroviral drugs for everyone who is found to be HIV-positive, even in the early stages of the disease -- has been shown to decrease the number of new HIV cases and deaths due to AIDS. The problem, according to the study, is that "such aggressive and widespread use of antiretroviral drugs would also rapidly and dramatically increase the prevalence of multiple-drug-resistant HIV (MDR)."

"We're not saying that testing everybody and treating everybody is bad. All we're saying is that you should proceed with caution and closely monitor the prevalence of multi-drug-resistant HIV as you scale up the test and treat model," said lead author Neeraj Sood, associate professor at the USC Schaeffer Center.

Sood and his colleagues studied the MSM population in L.A. County, which accounts for 82 percent of people living with HIV/AIDS countywide. They tracked how the disease was treated from 2000 to 2009 and how the virus responded. Using data from the Centers for Disease Control and their own data, the researchers then generated a model of how the disease would respond under a more aggressive "test and treat" policy over the next 10 years. The model showed the prevalence of MDR HIV jumping from 4.79% to 9.06% by 2023.

A more cautious approach, according to Sood, would be simply to aggressively test for the disease but avoid prescribing antiretroviral drugs to asymptomatic patients, in opposition to the current practice of many providers to start treatment early. (see "Timing and T-Cells" by HIV specialist Dr. Howard Grossman in Positively Aware's 17th Annual HIV Drug Guide).

This article was provided by Test Positive Aware Network. Visit TPAN's website to find out more about their activities, publications and services.

Reader Comments:

Comment by: Dale T. Read (Annapolis, MD) Thu., Apr. 4, 2013 at 8:07 pm UTC
I have received counsel and treatment form five different HIV / ID physicians since I was first diagnosed HIV positive in early 2006. I did not go on a regimen of Anti-viral medications until my CD-4$ finally went below 200 (it dropped very quickly form the 600 to 700 range to 193 almost overnight, and my viral load sky-rocketed up to 79,000 . Out of the five doctors I have had treat me two of them were very much opposed to early treatment with meds. one was somewhat for, but agreed that as long as I was healthy in terms of symptoms to hold off, and two became strong advocates for putting me on medications ..or said I should ahve gone on meds. early on. Studies and research kept changing during my period of being positive. I am tending to now in hindsight blame myself because I did not go on meds. earlier, yet it clearly appeared to be the right thing to not go no medications back in 2006 through 2010. My point is simple, the profession owes patients a simpler and guilt-free conclusion on this matter. There may be no one answer, but gentle persuasion and guidance within a guilt-free construct is vital for the patient to feel he / she has done his/her best to make the right decision.The real question should be since no one choice will be right for all patients, which choice or pattern of treatment has led to the greatest increases in life and hopefully healthy living. I trusted each and every doctor at the time believing that he was giving me the very best advice at the time. This is vital for a high level of patient confidence, and faithful patient compliance.We have to trust that the decision we make today will not be regretted tomorrow. Doctors need to not only be up on the latest research and findings but use these effectively to educate patients on the preferred course of action.
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