george nisyrios | One pill once a day and a normal life expectancy. Surely not HIV.
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Sep 22 2015

One pill once a day and a normal life expectancy. Surely not HIV.

The field of HIV medicine is somewhat fast paced.

Treatments are pushed through quite quickly from 48 week data to drug availability.  Guidelines are updated sometimes several times a year.  What held high as a preferred drug can be demoted overnight as new safety data is presented.  Trial data is presented at a few big international conferences each year, often in late breaker sessions, allowing for quick release from research team to public domain.

The last 18 months has seen new drugs, new combinations, changing guidelines, shifts away from drugs, shift towards drug classes, enhanced toxicity data, and new when-to-start treatment guidelines; all backed up by randomised controlled studies.

I am having conversations with patients about their treatment, that weren’t possible or high on the agenda even as close as a few months ago.

So where are we, September 2015, in Australia?

  • For naive patients, and many experienced patients, one tablet once a day with minimal or no side effects is almost the standard, and will probably mark the standard for the future
  • Switching patients who are virologically suppressed to less toxic regimens and easier to take regimens
  • No tolerance of any virological failure, meaning treatment should be working and robust, with quick intervention if otherwise
  • Treating early in the patient’s course, with no restriction based on immune CD4 level or viral load vs deferring and waiting for deterioration
  • Aiming for easy, effective, life long treatment with excellent control of the virus, good immune recovery and maintenance and a normal life expectancy for the patient
  • Treatment to help the patient and also prevent transmission, by viral load reduction as a public health measure
  • Routinely offering post exposure prophylaxis (PEP) following a risk exposure and working towards pre-exposure prophylaxis (PrEP) for high risk persons

We must remember though, that the greatest burden of infection is in resource poor countries where most of the above list is an ideal and not a reality.  On a global scale, that is what needs to be addressed urgently and through the WHO and UN AIDS optimistic targets have been set and some goals have been achieved.

The future I expect will see greater advances as technology and science rapidly develops.  I have always remained positive about the future, as HIV is not some rare cancer which affects only a few and attracts little funding.  Both government and private sector funding is drawn to research and development in preventing and managing HIV.  There are gaps but at least there has been much achieved in the last 10 years.

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