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What Is the Most Pressing Issue in HIV Care Today?

July 23, 2013


Melanie Thompson, M.D.

The Cascade

"One of the most interesting things to emerge in the last few years is this new concept of a care continuum or the cascade of care. What that shows is that we lose people from our health care system at multiple steps, multiple levels. We start out with about 20% of the U.S. population who we think have HIV, but they don't know it. Then we [have] the group of patients that are actually tested and they know their HIV status. [Then] we have a drop-off that is significant, in terms of engagement in care.

"Getting people who are HIV infected and known to be HIV infected into care is our first challenge, because we have a lot of treatments that are very effective, but if you're not in care, you can't get them.

"I think getting people into care efficiently and effectively is a huge challenge. I hope we will begin to see monitoring of that, because right now we don't really always know how many people are not linked to care.

"As we monitor that, I think we can begin to measure how well we do at getting people in care and then once they are linked to care, they have to stay in care to have effective antiretroviral therapy -- in terms of individual benefit -- and also to benefit society, in terms of HIV prevention."

-- Melanie Thompson, M.D., Founder and Principal Investigator, AIDS Research Consortium of Atlanta, Atlanta, Ga.

This article was provided by It is a part of the publication The 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013).

Reader Comments:

Comment by: John Marshall (Essex, Mass) Sat., Oct. 19, 2013 at 2:17 pm UTC
Thank you doctor, you understand what living with HIV means. Spread the word.
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Comment by: John Marshall (Essex, Mass) Sat., Oct. 19, 2013 at 2:12 pm UTC
Like most doctors, he tries to minimize the side effects of the meds. Severe adverse events stage 3/4 can happen. The number may be as high as 25% of patients. The meds are highly toxic and can be debilitating. The NRTIs cause a lot of irreversible damage to body chemistry. Diarrhea my ass.
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Comment by: bcilla13 (atlanta, ga) Tue., Sep. 10, 2013 at 12:49 pm UTC
treatment is without doudt the key to our survival i encourage everyone suffering from this illness to get into care and remain in care, the only way to sustain life span is by treating this disease aggressively.
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Comment by: todd jackman (Vancouver, bc) Fri., Aug. 2, 2013 at 4:15 pm UTC
is Cambrigde Ontario a good place for an HIV+ individual.Honestly please tell me if they are up to speed?
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