San Francisco Endorses New HIV Strategy: Begin HAART Therapy Immediately

Many HIV+ patients delay beginning anti-retroviral therapy for years after they become aware of their infection, waiting for signs that their immune system has begun to falter before starting treatment. San Francisco's Department of Health has just endorsed starting HAART treatment immediately upon diagnosis.

Behind the policy switch is mounting evidence that patients who start early are more likely to live longer, and less likely to suffer a variety of ailments — including heart disease, kidney failure and cancer — that plague long-term survivors. Studies suggest that in the early years of infection, when a patient may show few signs of immune system failure, the virus is in fact causing permanent damage that becomes evident later. For instance, in older patients who finally start taking the drugs, the effects of chronic inflammation take their toll. “The impact on health risk is comparable to that of diabetes,” said Dr. Steven G. Deeks, a researcher at the University of California, San Francisco.

“Their immune system may look like that of someone 30 years older.” Dr. Diane V. Havlir, chief of the H.I.V./AIDS division at San Francisco General Hospital, said the new policy was already in effect for her patients. Although a decision whether or not to take the medicine rests with the patient, all those testing positive for H.I.V. will be offered combination therapy, with advice to pursue it. “The history of H.I.V. disease has always been about change,” she said. “We pride ourselves on working quickly with new data.”

Today's HIV drugs are far, far less toxic than those available when HAART therapy first became available almost 15 years ago, but they are still very tough on some patients and their long-term side effects won't be known for decades. Some San Francisco-based HIV specialists quoted in the above-linked story strongly oppose the city's new directive.

(Tipped by JMG reader Ru)